Accessory soleus muscle (ASM) is a rare supernumerary anatomical variant that commonly presents as a posteromedial ankle swelling, which may become painful during physical activity. As it may mimic a ...soft tissue tumor, it is essential to differentiate this condition from ganglion, lipoma, hemangioma, synovioma, and sarcoma. However, ASM may also present with a painful syndrome, characterized by pain and paresthesia of the ankle and foot, mimicking the tarsal tunnel syndrome (TTS). Two cases of ASM are presented in this article. The first case had a typical presentation with painful posteromedial ankle swelling. After the initial assessment, the diagnosis was confirmed by magnetic resonance imaging (MRI), and ASM was treated by complete resection. The second case presented with pain and paresthesia in the right ankle and foot, but no swelling was noticeable. It was initially misdiagnosed by a rheumatologist and afterward overlooked on an MRI by a musculoskeletal radiology specialist and therefore mistreated by numerous physicians before being referred to our outpatient clinic. After further assessment, the diagnosis has been confirmed, and ASM was treated by complete resection combined with tarsal tunnel decompression. To the best of our knowledge, this is the first case reported in which ASM caused symptoms but presented without posteromedial swelling. This might be due to a proximally positioned belly of the ASM, followed by a tendinous insertion on the medial side of the calcaneus.
Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the ...superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB, which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach.
Os vesalianum (OV) is an accessory bone near the 5th metatarsal. It is usually asymptomatic, but might become painful.
Nineteen-year-old soccer player with bilateral OVs complained of right foot pain ...after exercise. MRI showed no findings that would explain symptoms with certainty. Bone scan with SPECT-CT showed abnormal metabolism in both OVs, while increased blood flow was seen only in the right OV, confirming the cause of pain. After surgical removal of right OV the patient was symptom-free.
Broad diagnostic workup should be performed in patients with disabling foot pain and presence of OV to avoid unnecessary surgery.
Os vesalianum (OV) ist ein akzessorischer Knochen nah an des Basis des fünften Mittelfußknochens. Es ist häufig asymptomatisch, es kann jedoch Schmerzen verursachen.
Ein 19-jähriger Fußballspieler mit beidseits bekannten Os vesalianum klagte über Schmerzen im rechten Fuß nach einer Trainingseinheit. Kernspintomographisch ergaben sich keine Befunde, die die Beschwerden erklären konnten. Die daraufhin durchgeführte SPECT-CT zeigte einen abnormalen Metabolismus der beiden OV, mit gesteigerter Durchblutung nur im Bereich des rechten OV, was die Ursache der Dolenz bestätigte. Nach chirurgischer Entfernung des OV war der Patient beschwerdefrei.
Bei Patienten mit immobilisierenden Fußschmerzen und vorbestehenden Os vesalianum ist eine ausführliche Diagnostik erforderlich um unnötige chirurgische Eingriffe zu vermeiden.
Primary bone tumors of the fibula are rare. Distal fibular resection has a significant impact on ankle biomechanics and gait, possibly leading to complications such as ankle instability, valgus ...deformity, and degenerative changes. Question: Is there a need for reconstructive surgery after distal fibular resection, and what reconstructive procedures are available?
The review is registered with the PROSPERO International Register of Systematic Reviews. Inclusion criteria consisted of all levels of evidence, human studies, patients of all ages and genders, publication in English, and resection of the distal portion of the fibula due to tumor pathology. The reviewers defined four different categories of interest by method of treatment. Additional articles of interest during full-text review were also added.
The initial search resulted with a total of 2958 records. After screening, a total of 50 articles were included in the study. Articles were divided into 'No reconstruction', 'Soft tissue reconstruction', 'Bone and soft tissue reconstruction', and 'Arthrodesis, arthroplasty or other reconstruction options' groups.
Limb salvage surgery should be followed by reconstruction in order to avoid complications. Soft tissue reconstructions should always be considered to stabilize the joint after fibular resection. Bone reconstruction with reversed vascularized fibula is the preferred technique in young patients and in cases of bone defects more than 3 cm, while arthrodesis should be considered in adult patients. Whenever possible for oncologic reason, if a residual peroneal malleolus could be preserved, we prefer augmentation with a sliding ipsilateral fibular graft.
Osteoarthritis (OA) is a degenerative joint disease accompanied by pain and loss of function. Adipose tissue harbors mesenchymal stem/stromal cells (MSC), or medicinal signaling cells as suggested by ...Caplan (Caplan, 2017), used in autologous transplantation in many clinical settings. The aim of the study was to characterize a stromal vascular fraction from microfragmented lipoaspirate (SVF-MLA) applied for cartilage treatment in OA and compare it to that of autologous lipoaspirate (SVF-LA). Samples were first stained using a DuraClone SC prototype tube for the surface detection of CD31, CD34, CD45, CD73, CD90, CD105, CD146 and LIVE/DEAD Yellow Fixable Stain for dead cell detection, followed by DRAQ7 cell nuclear dye staining, and analyzed by flow cytometry. In SVF-LA and SVF-MLA samples, the following population phenotypes were identified within the CD45
fraction: CD31
CD34
CD73
CD90
CD105
CD146
endothelial progenitors (EP), CD31
CD34
CD73
CD90
CD105
CD146
mature endothelial cells, CD31
CD34
CD73
CD90
CD105
CD146
pericytes, CD31-CD34
CD73
CD90
CD105-CD146
transitional pericytes, and CD31
CD34
CD73
CD90
CD105
CD146
supra-adventitial-adipose stromal cells (SA-ASC). The immunophenotyping profile of SVF-MLA was dominated by a reduction of leukocytes and SA-ASC, and an increase in EP, evidencing a marked enrichment of this cell population in the course of adipose tissue microfragmentation. The role of EP in pericyte-primed MSC-mediated tissue healing, as well as the observed hormonal implication, is yet to be investigated.
The aim of our study was to compare acetabular cartilage affected by primary and DDH-induced secondary osteoarthritis (OA) using T2 mapping, which gives us information about cartilage water and ...collagen content, and the orientation of collagen fibrils. Samples of the osteochondral unit were obtained intraoperatively during total hip arthroplasty from the acetabulum of 15 patients with primary OA (pOA-Ac) and 15 patients with DDH-induced secondary OA (sOA-Ac). The samples were then scanned on a 7 Tesla micro-magnetic resonance imaging (micro-MRI) machine and the T2 values of all samples were calculated. The results were compared using a t-test. The average T2 values for the sOAAc and pOA-Ac groups were 57.28±31.87 ms and 37.54±11.17 ms, respectively. The calculated p-value was 0.019, making results statistically significant at p<0.05. This is one of the first studies performed ex vivo on the acetabular cartilage of human dysplastic hips, using a 7 Tesla MRI machine. Our results show that acetabular cartilage in DDH-induced secondary OA is more damaged than in primary OA, and offer 7 Tesla T2 reference values of acetabular cartilage for both the primary and DDH-induced secondary OA.
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