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Kinoshita T, Hashimoto Y, Inui K, Sugama R, Sugimoto T, Akizuki Y, Nakamura H. Male elite soccer players have a higher incidence of accessory ossicles in the foot and ankle. INTERNATIONAL ORTHOPAEDICS 2024; 48:1049-1055. [PMID: 38146004 DOI: 10.1007/s00264-023-06074-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Accessory ossicles are caused by the failure of the fusion of secondary ossification centres and are more likely to occur due to heavy loading during the growth period or improper treatment after injury. This study aimed to investigate the incidence of foot and ankle accessory ossicles in male professional soccer players. METHODS This study included male professional soccer players who underwent medical checkups at our hospital between 2017 and 2023 as the soccer group. Medical checkups included radiographs of bilateral anteroposterior and oblique foot, as well as bilateral anteroposterior and lateral ankle. Male patients age-matched with the soccer group who visited our hospital undergoing anteroposterior and oblique foot or anteroposterior and lateral ankle radiography were included in the control group. The incidence of accessory ossicles was investigated and compared between the soccer and control groups. RESULTS In this study, 276 ankles and 276 feet, as well as 121 ankles and 79 feet, were included in the soccer and control groups, respectively. The incidence of accessory ossicles in the soccer and control groups was as follows: accessory navicular 35.9%, 24% (P = .049), os peroneum 8.0%, 2.5% (P = .09); os supranaviculare 7.6%, 1.3% (P = .039); os infranaviculare 1.4%, 1.3% (P = .090); os calcaneus secundarius 4.3%, 0% (P = .059); os vesalianum 0%, 0%; os subfiblare 12.7%, 2.5% (P < .001); os subtibiale 18.1%, 2.5% (P = .001); and os trigonum 89%, 24% (P < .001). CONCLUSIONS Male professional soccer players had a higher incidence of accessory navicular, os supranaviculare, os subfiblare, os subtibiale, and os trigonum.
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Affiliation(s)
- Takuya Kinoshita
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Osaka, Kita-ku, 530-0012, Japan.
| | - Yusuke Hashimoto
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Health and Sport Management, Graduate School of Sport and Exercise Science, Osaka University of Health and Sports Science, Osaka, Japan
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Osaka, Kita-ku, 530-0012, Japan
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Sugimoto
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Osaka, Kita-ku, 530-0012, Japan
- Department of Orthopaedic Surgery, Osaka Global Orthopedic Hospital, Osaka, Japan
| | - Yuichi Akizuki
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Osaka, Kita-ku, 530-0012, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Zgoda M, Arnold MCA. Surgical treatment of ankle instability in children with os subfibulare. Arch Orthop Trauma Surg 2023; 143:6123-6129. [PMID: 37246999 PMCID: PMC10491692 DOI: 10.1007/s00402-023-04905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/02/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Ankle instability in children due to soft tissue injury usually resolves after non-operative treatment. However, some children and adolescents with chronic instability require surgical treatment. A rarer cause of developing ankle instability is injury to the ligament complex in the presence of os subfibulare, an accessory bone inferior to the lateral malleolus. The aim of this study was to assess the results of operative management of chronic ankle instability in children with os subfibulare. MATERIALS AND METHODS 16 children with os subfibulare and chronic ankle instability who failed non-operative treatment were enrolled prospectively into the study. One child was lost to follow-up and excluded from analysis. The mean age at the time of the surgery was 14 years and 2 months (range 9.5-17 years). The mean follow-up time was 43.2 months (range 28-48 months). Surgical treatment in all cases involved removal of os subfibulare and a modified Broström-Gould lateral complex reconstruction with anchors. Ankle status was assessed before and after surgery with The 100 mm Visual Analogue Scale and Foot and Ankle Outcome Score questionnaire. RESULTS The mean Foot and Ankle Outcome Score improved from 66.8 to 92.3 (p < 0.001). Pain level improved from 67.1 preoperatively to 12.7 (p < 0.001). All children reported improvement in their ankle stability. There was one case of scar hypersensitivity that improved during observation and one superficial wound infection that resolved with oral antibiotics. One child reported intermittent pain without symptoms of instability following another injury. CONCLUSIONS Ankle joint sprain with associated injury to os subfibulare complex can lead to chronic instability in children. If conservative management fails, then surgical treatment with modified Broström-Gould technique and excision of accessory bone is a safe and reliable method.
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Affiliation(s)
- Marcin Zgoda
- Department of Trauma and Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, KA2 0BE Scotland
| | - Matthew C. A. Arnold
- Department of Trauma and Orthopaedic Surgery, University Hospital Crosshouse, Kilmarnock Road, Crosshouse, KA2 0BE Scotland
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Lee SH, Yang JH, Kim I. Anatomic Anterior Talofibular Ligament Repair: Response. Am J Sports Med 2022; 50:NP61-NP64. [PMID: 36472486 DOI: 10.1177/03635465221125441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Llanes ACD, Van Tassel D, Wirth A, Goncalves LF, Belthur MV. Optimal Visualization of Os Subfibulare Using 3D Water Selective Cartilage Scan (3D_WATSc) MRI Sequencing: A Case Report. Cureus 2022; 14:e27469. [PMID: 36060334 PMCID: PMC9421124 DOI: 10.7759/cureus.27469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
Os subfibulare is an accessory ossicle of the lateral malleolus at the distal end of the fibula. In most instances, os subfibulare is found incidentally on radiographs. While os subfibulare typically remains asymptomatic, some cases may present with ankle pain or instability. To initiate appropriate treatment and maximize patient outcomes, it is crucial to accurately visualize the accessory ossicle. Here, we report a symptomatic case of os subfibulare diagnosed with ankle radiographs and a 3D water selective cartilage scan (3D_WATSc, Ingenia, Philips Healthcare, The Netherlands) magnetic resonance imaging sequence and treated surgically with open ossicle excision and a modified Broström procedure.
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唐 一, 梁 晓, 赵 宏, 张 言. [Progress in diagnosis and treatment of fibular fracture in ankle fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:117-121. [PMID: 35038809 PMCID: PMC8844619 DOI: 10.7507/1002-1892.202108091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To summarize the diagnosis and treatment of fibular fracture in ankle fracture. METHODS Relevant literature at home and abroad in recent years was widely consulted, and various types of fractures were discussed and summarized according to Danis-Weber classification. RESULTS Conservative treatment is not an ideal treatment for type A avulsion fracture. The operation method should be determined according to the position and size of bone mass. For simple type B fracture, both conservative treatment and surgical treatment can achieve good results. When the position of type C fracture is high and does not affect the stability of ankle joint, it can be treated conservatively, while when the position is low and affects the stability of ankle joint, it needs surgical treatment. CONCLUSION First of all, whether the fibular fracture in the ankle fracture is stable or not should be determined. Whether it is treated surgically or not, the purpose is to restore the tibiofibular syndesmosis and restore the motor function of the ankle.
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Affiliation(s)
- 一丁 唐
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
| | - 晓军 梁
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
| | - 宏谋 赵
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
| | - 言 张
- 西安医学院附属红会医院足踝外科(西安 710054)Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi’an Medical College, Xi’an Shaanxi, 710054, P. R. China
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Husebye EE, Stødle A, Lund-Iversen M, Hvaal K. Unilateral, Volume-expanding Os Subcalcis: Patient History and Treatment: A Case Report. J Foot Ankle Surg 2021; 60:209-212. [PMID: 33168442 DOI: 10.1053/j.jfas.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
Accessory bones of the foot are common, but the presence of accessory bones located at the plantar aspect of the calcaneus is rare. We present the case of a 72-year-old female that suffered with a volume expanding os subcalcis. Due to marked disability, the large os subcalcis was excised with a favorable outcome.
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Affiliation(s)
| | - Are Stødle
- Foot and Ankle Surgeon, Division of Ortopaedic Surgery, Oslo University Hospital, Norway
| | - Marius Lund-Iversen
- Pathologist, Department of Pathology, Division of Laboratory Medicine, Oslo University Hospital, Norway
| | - Kjetil Hvaal
- Foot and Ankle Surgeon, Division of Ortopaedic Surgery, Oslo University Hospital, Norway
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Abstract
BACKGROUND A subfibular ossicle (SO), also known as an os subfibulare, is present in ∼1% of the general population. Two theories have been proposed to explain the origin of SOs: (1) as a failure of fusion of a secondary center of ossification; (2) as a posttraumatic sequela. This report offers prospective, longitudinal radiographic evidence for the formation of SOs as a posttraumatic sequela of type VII transepiphyseal fractures of the lateral malleolus in children. METHODS This Institutional Review Board-approved study was performed at a tertiary care pediatric hospital from March 2012 to April 2019. The study group included 37 children with a type VII fracture of the lateral malleolus and a minimum follow-up of 6 months. RESULTS Twenty-one children (57%) healed their fracture. Sixteen children (43%) went on to form SOs. The most common location for the fractures was the distal third of the epiphysis, and the most common fracture type forming SOs was a sleeve avulsion fracture. Four of the children forming SOs have had surgery to address pain and recurrent sprains. CONCLUSIONS Overall, 43% of children who sustained a type VII fracture of the lateral malleolus went on to form SOs, giving support to the posttraumatic theory of origin. Sleeve avulsion fractures have the greatest chance of forming SOs. So far, 4 of the 16 children forming SOs have undergone surgery for ankle pain and recurrent sprains. LEVEL OF EVIDENCE Level II.
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Lee JH, Kyung MG, Cho YJ, Go TW, Lee DY. Prevalence of Accessory Bones and Tarsal Coalitions Based on Radiographic Findings in a Healthy, Asymptomatic Population. Clin Orthop Surg 2020; 12:245-251. [PMID: 32489548 PMCID: PMC7237265 DOI: 10.4055/cios19123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background Accessory bones and tarsal coalitions are the most common developmental variations of the foot and ankle. However, their clinical implications are not well understood because there is no established prevalence data in the normal population and the reported prevalence varies widely. Therefore, we aimed to investigate the incidence of accessory ossicles and tarsal coalitions in a healthy, asymptomatic Korean population. Methods A total of 448 healthy, asymptomatic participants (224 men and 224 women; 896 feet) were enrolled and stratified by age and sex. To investigate the presence of accessory bones and tarsal coalitions in the foot and ankle, we obtained the weight-bearing standing radiographs (anteroposterior and lateral views) from each participant. Results Accessory ossicles were found in 49.2% of the healthy, asymptomatic Korean adults. The prevalence of accessory bones in adults was the highest with 34% for the accessory navicular, 5.8% for the os trigonum, 3.9% for the os peroneum, and 1.7% for the os subfibulare. The prevalence of tarsal coalitions in adults was 0.4% and that of symphalangism was 16% for the fourth toe and 80.6% for the fifth toe. The frequency of the accessory navicular and fifth toe symphalangism was significantly higher in women. Most of the accessory navicular and fourth and fifth toe symphalangism were bilateral, whereas the os subfibulare was mostly unilateral. Conclusions The prevalence of accessory bones and tarsal coalitions in the healthy, asymptomatic Korean population showed some variation according to age and sex.
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Affiliation(s)
- Jae Hee Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yun Jae Cho
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Tae Won Go
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Lee DJ, Shin HS, Lee JH, Kyung MG, Lee KM, Lee DY. Morphological Characteristics of Os Subfibulare Related to Failure of Conservative Treatment of Chronic Lateral Ankle Instability. Foot Ankle Int 2020; 41:216-222. [PMID: 31665918 DOI: 10.1177/1071100719884056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The os subfibulare is usually asymptomatic and found incidentally on radiographs. However, sometimes it may cause subfibular pain and may be associated with chronic lateral ankle instability (CLAI). We hypothesized that os subfibulare could interrupt the talofibular space causing impingement, resulting in chronic pain and functional instability around the lateral malleolus. The purposes of this study were to analyze morphologic characteristics of os subfibulare, and to evaluate the clinical significance of the os subfibulare in patients with CLAI. METHODS Between November 2011 and April 2015, 70 patients who had both computed tomography (CT) and magnetic resonance imaging (MRI) among 252 patients who visited our hospital with the symptom of lateral ankle instability were included in this study. The location of the ossicle was classified into 3 zones in reference to the attachment site of the lateral ankle ligaments. The impingement was classified into 2 groups according to the presence of talofibular encroachment. Digital radiographs were used to measure the ossicle width and shape determined by the length and width on an magnetic resonance (MR) image. RESULTS The most common shape of ossicles was oval, and the most common location of ossicles was at the anterior talofibular ligament (ATFL) attachment site. Sixty-one percent of patients showed talofibular impingement on coronal MR images. In 48 cases, the dimension of fibula plus os subfibulare was larger than that of the contralateral normal fibula. The larger size and talofibular impingement of the ossicle were associated with greater need for operative treatment in patients with ankle instability. CONCLUSION The morphologic analysis of the os subfibulare revealed that there might be impingement of the talofibular space by the ossicle in some patients. We suggest that morphologic characteristics of the os subfibulare should be considered when selecting treatment options in patients with CLAI and os subfibulare. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Doo Jae Lee
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chunchun, South Korea
| | - Hyuck Soo Shin
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Hee Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
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Posttraumatic Subfibular Ossicle Formation in Children: Experience in a Single Primary Care Unit: Erratum. J Pediatr Orthop 2019; 39:216. [PMID: 30839488 DOI: 10.1097/bpo.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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