Determination of Frequency of Sesamoid Bones and Accessory Ossicles in Foot and Ankle in Patients Admitted to Emergency Service

Yıl 2022, Cilt: 44 Sayı: 1, 37 - 44, 14.01.2022

Abdülkadir Bilir , Emre Atay , Ayşe Ertekin

https://doi.org/10.20515/otd.939102

Öz

Accessory ossicles and sesamoid bones are bone structures that have completed ossification that mimic fractures and cause various diseases in the foot. They are discovered by chance on radiographs and are often overlooked, and lead to misdiagnosis. For this reason, it was aimed to determine the frequency of the accessory ossicles and sesamoid bones in the radiographic images of the patients who were admitted to the emergency department with foot and ankle complaints. Anteroposterior, oblique and lateral foot radiographs of patients (506) admitted to the Emergency Service were evaluated retrospectively. The presence, prevalence, coexistence and distribution of accessory ossicles and sesamoid bones were analyzed in detail according to gender and extremity sides. In 506 foot radiographs, accessory ossicles were detected in 18.4% and sesamoid bones in 86.4%. The most common accessory ossicles were accessory navicular (11.5%), os peroneum (3.6%), os trigonum (1.8%), os supranaviculare (0.4%), os vesalianum (0.2%), os supratalare (0.2%), os subfibulare (%0.6) ve os calcaneus secundarius (%0.2). We observed hallux sesamoid in 86.4% of radiographs. Interphalangeal sesamoid bone of the hallux was seen in 2% of radiographs. Incidences of MTP I were found as 2% in the MTP II, 0.4% MTP IV and 6.7% MTP V. In conclusion, although the results of the study are within the ranges stated in the literature, they differ significantly from other literature reports because the study group consisted of different population and age groups and only patients who applied to the emergency department were included.

Anahtar Kelimeler

Accessory ossicles; Anatomy; Emergency service; Sesamoid bones

Acil Servise Başvuran Hastalardaki Sesamoid Kemiklerin ve Aksesuar Kemikçiklerin Ayak ve Ayak Bileğindeki Görülme Sıklığının Belirlenmesi

Öz

Aksesuar kemikçikler ve sesamoid kemikler, ayakta çeşitli hastalıklara neden olan ve kırıkları taklit eden kemikleşmesini tamamlamış kemik yapılardır. Radyografilerde tesadüfen keşfedilirler ve çoğu zaman gözden kaçırılarak yanlış teşhislere yol açarlar. Bu nedenle, acil servise ayak ve ayak bileği şikâyeti ile başvuran hastaların radyografi görüntülerinde aksesuar kemikçik ve sesamoid kemiklerin görülme sıklığının belirlenmesi amaçlandı. Acil Servisi başvuran hastalara ait anteroposterior, oblik ve lateral ayak grafileri (506) retrospektif olarak değerlendirildi. Aksesuar kemikçiklerin ve sesamoid kemiklerin varlığı, prevalansı, bir arada bulunuşu ve dağılımı cinsiyete ve ekstremite tarafına göre detaylı olarak analiz edildi. 506 ayak grafisinde, %18.4 oranında aksesuar kemikçik, % 86.4 oranında sesamoid kemik tespit edildi. En yaygın aksesuar kemikçikler; os naviculare accessorium (%11.5), os peroneum (%3.6), os trigonum (% 1.8), os supranaviculare (%0.4), os vesalianum (%0.2), os supratalare (%0.2), os subfibulare (% 0.6) ve os calcaneus secundarius (%0.2)’tur. Radyografilerin %86.4'ünde halluks sesamoid gözlemlendi. Halluks’un interfalangeal sesamoid kemiği, radyografilerin %2'sinde görüldü. Metatarsofalangeal sesamoid kemik insidansı MTP II’de % 2, MTP IV’te % 0.4 ve MTP V’te % 6.7 olarak bulundu. Çalışmanın sonuçları literatürde belirtilen aralıklarda olmasına rağmen, çalışma grubunun farklı populasyon ve yaş gruplarından oluşması ve sadece acil servise başvuran hastaların dahil edilmesi nedeni ile diğer literatür raporlardan önemli ölçüde farklı göstermektedir.

Anahtar Kelimeler

Aksesuar kemikçikler, Anatomi, Acil servis, Sesamoid kemikler

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(1):19–24.
• Vora BMK, Wong BSS. Common accessory ossicles of the foot: Imaging features, pitfalls and associated pathology. Singapore Med J. 2018;59(4):183–9.
• 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(4):164–77.
• Coughlin MJ, Mann RA, Saltzman CL, et al. Sesamoid and accessory bones of the foot. In: Surgery of the foot and ankle. 8th ed. Amsterdam: Elsewier; 2006. p. 438–494.
• Lawson JP. International Skeletal Society Lecture in honor of Howard D. Dorfman. Clinically significant radiologic anatomic variants of the skeleton. Am J Roentgenol. 1994;163:249–55.
• Kiter E, Akkaya S, Kiliç BA, et al. Distribution of the Metatarsophalangeal Sesamoids in Turkish Subjects. J Am Podiatr Med Assoc. 2006 Sep 1;96(5).
• Alfaraj DN, Vilke GM. Tripartite Fracture of the Ulnar Sesamoid Bone of the Thumb. J Emerg Med. 2017;53(5):758–9.
• Longo UG, Marinozzi A, Petrillo S, et al. Prevalence of accessory ossicles and sesamoid bones in hallux valgus. J Am Podiatr Med Assoc. 2013;103(3):208–12.
• Sarrafian SK. Anatomy of the foot and ankle. In: Sarrafianan SK, editor. Osteology. Philadelphia: Lippincott; 2012. p. 89–112.
• Miller TT. Painful accessory bones of the foot. Semin Musculoskelet Radiol. 2002;6(2):153–61.
• Chan BY, Keegan Markhardt B, Williams KL, et al. OS conundrum: Identifying symptomatic sesamoids and accessory ossicles of the foot. Am J Roentgenol. 2019;213(2):417–26.
• Shands ARJ, Wentz IJ. Congenital anomalies, accessory ossicles, and osteochondritis in the feet of 850 children. Surg Clin North Am. 1953;33(6):1643–66.
• Tsuruta T, Shiokawa Y, Kato A, et al. Radiological study of the accessory skeletal elements in the foot and ankle. J Japanese Orthop Assoc. 1981;55(4).
• Kruse RW, Chen J. Accessory Bones of the Foot: Clinical Significance. Mil Med. 1995 Sep 1;160(9).
• Cilli F, Akçaoglu M. The incidence of accessory bones of the foot and their clinical significance. Acta Orthop Traumatol Turc. 2005;39(3).
• Guo S, Yan YY, Lee SSY, et al. Accessory ossicles of the foot—an imaging conundrum. Emerg Radiol. 2019;26(4):465–78.
• Gökkuş K, Sagtas E, Demirci E, et al. Degenerative arthritis of pseudoarticulation between the os peroneum and cuboid: A rare cause of lateral foot pain. Foot Ankle Surg. 2015;
• Sobel M, Pavlov H, Geppert MJ, et al. Painful Os Peroneum Syndrome: A Spectrum of Conditions Responsible for Plantar Lateral Foot Pain. Foot Ankle Int. 1994 Mar 28;15(3).
• Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: Anatomical variability and related pathology. Insights into Imaging. 2013.
• Lee JC, Calder JDF, Healy JC. Posterior impingement syndromes of the ankle. Seminars in Musculoskeletal Radiology. 2008; 12(02):154-169.
• 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(8):1072–6.
• Boya H, Özcan Ö, Tandoǧan R, et al. Os vesalianum pedis. J Am Podiatr Med Assoc. 2005; 95.6: 583-585.
• Goldberg I, Nathan H. Anatomy and pathology of the sesamoid bones - The hand compared to the foot. Int Orthop. 1987;11(2).
• Sarin VK, Erickson GM, Giori NJ, et al. Coincident development of sesamoid bones and clues to their evolution. Anat Rec. 1999 Oct 15;257(5).
• Dedmond BT, Cory JW, McBryde A. The hallucal sesamoid complex. J Am Acad Orthop Surg. 2006;14(13):745–53.
• Davies MB, Dalal S. Gross anatomy of the interphalangeal joint of the great toe: Implications for excision of plantar capsular accessory ossicles. Clin Anat. 2005;18(4):239–44.
• Roukis TS, Hurless JS. The hallucal interphalangeal sesamoid. J Foot Ankle Surg. 1996 Jul;35(4).
• Dharap AS, Al-Hashimi H, Kassab S, et al. Incidence and ossification of sesamoid bones in the hands and feet: A radiographic study in an Arab population. Clin Anat. 2007 May;20(4).
• Bizarro FRCS. On sesamoid and supernumerary bones of the limbs. J Anat. 1921;55(4):256.
• Jahss MH. The sesamoids of the hallux. Clin Orthop Relat Res. 1981;157:88–96.