Accessory and Sesamoid Bones in the Body: A study on their Size and Presence

Yıl 2024, Cilt: 6 Sayı: 1, 50 - 57, 31.01.2024

Muhammet Değermenci Ali Aygün Halil Yılmaz Adem Tokpınar Orhan Bas

https://doi.org/10.37990/medr.1358230

Öz

Aim: Accessory and sesamoid bones are hidden anatomical structures that fulfil a wide variety of functions in the human body. Therefore, studying the nature, formation and dimensions of these structures is of great importance for the medical literature. In our study, we aimed to measure the presence and area (size) of these ossicles.
Material and Method: Our study was performed retrospectively on the images of individuals who applied to Ordu University and whose radiological images were obtained. The presence of accessory and sesamoid ossicles (present/absent) and their sizes (measured using the PACS system) were evaluated on radiographs and Computed Tomography (CT) images. The results of the ossicles were divided into gender, age, and bilateral groups. Statistical analyzes were performed with the SPSS program.
Results: The most common and largest accessory ossicles in the foot were os peroneum (18.2%), os naviculare accessoria (17.4%), os trigonum (12.1%) and os intermetatarsarum (7.8%). Sesamoid ossicles at the level of the first metatarsophalangeal (mtp) joint of the foot and the first metacarpopgalangeal (mcp) joint of the hand were found to be 100% common. The second most common sesamoid bone in the hand and foot was at the fifth mtp (22.22%) and mcp (68.53%) joints. In the hand, the most common accessory ossicles were os triangulare (6.08%), os radiale externum (2.60%) and os centrale (1.73%). Accessory ossicles (fabella: 19%, cyamella: 17.5%) were found in 25.5% of the knee.
Conclusion: Accessory and sesamoid ossicles are most commonly found in the hand, foot, and knee. The presence and size of these ossicles can be both beneficial and harmful. Sesamoids provide mechanical benefit, whereas accessory ossicles can be mistaken for fractures and may lead to unnecessary medical conditions. Knowing the dimensions of these ossicles allows them to be clinically differentiated from avulsion fractures.

Anahtar Kelimeler

Accessory ossicles, Sesamoid ossicles, Morphometry, Radiograph

Kaynakça

• Coskun N, Yuksel M, Cevener M, et al. Incidence of accessory ossicles and sesamoid bones in the feet: a radiographic study of the Turkish subjects. Surg Radiol Anat. 2009;31:19-24.
• Coughlin MJ. Sesamoid and accessory bones of the foot. In: Surgery of the foot and ankle. 8th edition. Elsevier, Amsterdam, 2007;438-94.
• Mespreuve M, Bosmans F, Waked K, Vanhoenacker FM. Hand, and wrist: a kaleidoscopic view of accessory ossicles, variants, coalitions, and others. Semin Musculoskelet Radiol. 2019;23:511-22.
• Mellado JM, Ramos A, Salvadó E, et al. Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance, and differential diagnosis. Eur Radiol. 2003;13:164-77.
• Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 2013;4:581-93.
• Fu X, Ma L, Zeng Y, et al. Implications of classification of os trigonum: a study based on computed tomography three-dimensional imaging. Med Sci Monitor. 2019;25:1423-8.
• Lee JH, Kyung MG, Cho MG, et al. Prevalence of accessory bones and tarsal coalitions based on radiographic findings in a healthy asymptomatic population. Clin Orthop Surg. 2020;12:245-51.
• Amar E, Rozenblat Y, Chechik O. Sesamoid, and accessory bones of the hand-an epidemiologic survey in a Mediterranean population. Clin Anat. 2011;24:183-7.
• Chen W, Cheng J, Sun R, et al. Prevalence, and variation of sesamoid bones in the hand: a multi-center radiographic study. Int J Clin Exp Med. 2015;8:11721-6.
• White TD. Human Osteology. 2nd edition. Academic Press, San Diego, 2000;257-61.
• Reesink HL. Foal fractures: osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Vet Clin North Am Equine Pract. 2017;33:397-416.
• Goldberg I, Nathan H. Anatomy, and pathology of the sesamoid bones. The hand compared to the foot. Int Orthop. 1987;11:141-7.
• Debnar M, Kopp L, Baba V, Rammelt S. Accessory bones at the foot and ankle: a comprehensive review. Fuß & Sprunggelenk. 2023;21:121-37.
• Cilli F, Akcaoglu M. The incidence of accessory bones of the foot and their clinical significance. Acta Orthop Traumatol Turc. 2005;39:243-6.
• Candan B, Torun E, Dikici R. The prevalence of accessory ossicles, sesamoid bones, and biphalangism of the foot and ankle: a radiographic study. Foot Ankle Orthop. 2022;7:24730114211068792.
• Kalbouneh H, Alajoulin O, Shawaqfeh J, et al. Accessory ossicles in the region of the foot, and ankle: an epidemiologic survey in a Jordanian population. Medicina. 2021;57:1178.
• Kır H, Kandemir S, Olgaç M, et al. Ayaktaki aksesuar kemiklerin görülme sıklığı ve dağılımı. The Medical Bulletin of Şişli Etfal Hospital. 2011;45:44-7.
• Guo S, Yan YY, Lee SSY, Tan TJ. Accessory ossicles of the foot—an imaging conundrum. Emerg Radiol. 2019;26:465-78.
• Kose O, Okan AN, Durakbasa MO, et al. Fracture of the os trigonum: a case report. J Orthop Surg. 2006;14:354-6.
• Yan YY, Mehta KV, Tan TJ. Fracture of the os trigonum: a report of two cases and review of the literature. Foot Ankle Surg. 2016;22:e21-4.
• Zwiers R, Baltes TPA, Opdam KTM, et al. Prevalence of Os trigonum on CT imaging. Foot Ankle Int. 2018;39:338-42.
• Muehleman C, Williams J, Bareither ML. A radiologic and histologic study of the os peroneum: Prevalence, morphology, and relationship to degenerative joint disease of the foot and ankle in a cadaveric sample. Clin Anat. 2009;22:747-54.
• Arslan S, Bakdik S, Oncu F, et al. Incidence and anatomical variability of accessory and sesamoid bones of the foot. Ann Med Res. 2018;25:420-5.
• Huang J, Zhang Y, Ma X, et al. Accessory navicular bone incidence in Chinese patients: a retrospective analysis of X-rays following trauma or progressive pain onset. Surg Radiol Anat. 2014;36:167-72.
• Miller TT, Staron RB, Feldman F, et al. The symptomatic accessory tarsal navicular bone: assessment with MR imaging. Radiology. 1995;195:849-53.
• Koo BS, Song Y, Lee S, et al. Prevalence and distribution of sesamoid bones and accessory ossicles of the foot as determined by digital tomosynthesis. Clin Anat. 2017;30:1072-6.
• Dharap AS, Al-Hashimi H, Kassab S, Abu-Hijleh MF. Incidence and ossification of sesamoid bones in the hands and feet: a radiographic study in an Arab population. Clin Anat. 2007;20:416-23.
• Seki Y, Hoshino Y, Kuroda H. Prevalence of sesamoid bones in the interphalangeal joint of the thumb and fingers: a radiographic study. Clin Anat. 2013;26:823-6.
• Akkoc RF, Aksu F, Emre E, et al. The morphology of fabella and its prevalence in Turkish society. Eur Rev Med Pharmacol Sci. 2022;26:1164-9.