ABSTRACT
PURPOSE: the os trigonum is a supernumerary bone that may lead to posterior ankle impingement syndrome. The present study aims to assess the prevalence of this bone. METHODS: A meta-analysis regarding the presence of the os trigonum was performed. For this, the MEDLINE and SciElo databases were searched using "os trigonum" as the keyword. Only original articles, theses, books, dissertations, and monographs were included. Papers with a sample size of < 50 individuals were excluded. The data extracted from the articles were: the total sample size, the prevalence of the trigonum, the method of analysis, the region of the sample, and data regarding sex and side (left or right). Statistical analysis was performed using MedCalc Statistical Software version 14.8.1 (MedCalc Software bvba, Ostend, Belgium). The heterogeneity between the studies was assessed using the I² estimation and the Cochran Q test. For all analyses, a random effect was used and a value of p < 0.05 was considered significant. RESULTS: 249 papers were found, while 18 were included in the meta-analysis. A total of 17,626 ankles were included. The pooled prevalence of the os trigonum was 10.3% (95% CI 7-14.1%) in the present study. There was no significant difference regarding sex or side, while studies conducted in imaging exams showed a higher prevalence in comparison to cadaveric studies. CONCLUSION: Our results suggest that the os trigonum is relatively common. Knowledge of the prevalence of the os trigonum may help surgeons and clinicians diagnose posterior ankle impingement syndrome.
Subject(s)
Ankle Joint , Talus , Humans , Prevalence , Talus/abnormalities , Anatomic Variation , Female , MaleABSTRACT
SUMMARY: The aim of our study was to determine the prevalence and the anatomical variations of the posterolateral tubercle of talus in relation to sex on CT imaging. A total of 1478 ankle CT scans was retrospectively reviewed for the different anatomical variants of the posterolateral tubercle of talus, the type and size of os trigonum. Normal sized lateral tubercle was found in 46.1 %, an enlarged posterolateral tubercle (Stieda's process) in 26.1 %, os trigonum in 20.5 % and almost absent tubercle in 7.3 %. A statistically higher prevalence of Stieda's process was found in males while os trigonum was higher in females (p0.05). The posterolateral tubercle of talus and its accessory ossicle, the os trigonum, could vary morphologically. The data of this study could be helpful in understanding the clinical problems that could be associated with some of these variants.
RESUMEN: El objetivo de nuestro estudio fue determinar la prevalencia y las variaciones anatómicas del tubérculo posterolateral del talo en relación con el sexo en la imagen de TC. Se revisaron retrospectivamente un total de 1478 TC de tobillo para las diferentes variantes anatómicas del tubérculo posterolateral del talo, el tipo y tamaño del os trigonum. Se encontró tubérculo lateral de tamaño normal en 46,1 %, tubérculo posterolateral (proceso de Stieda) en 26,1 %, os trigonum en 20,5% y tubérculo casi ausente en 7,3 %. Se encontró una prevalencia estadísticamente más alta del proceso de Stieda en los hombres, mientras que el os trigonum fue mayor en las mujeres (p 0,05) no se observaron diferencias significativas. El tubérculo posterolateral del talo y su osículo accesorio, el os trigonum, podrían originar problemas clínicos que podrían estar asociados con algunas de estas variantes.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Talus/anatomy & histology , Anatomic Variation , Talus/diagnostic imaging , Sex Factors , Retrospective StudiesABSTRACT
SUMMARY: The Stieda process (SP) and os trigonum (OT) are primary risk factors for posterior ankle impingement syndrome. The aim of this study was to elucidate the prevalence of the elongated lateral tubercle of the posterior talar process (SP) and OT in Turkish subjects using lateral ankle radiographs. In this study, 1088 ankle radiographs in the lateral view were evaluated retrospectively using a picture archiving and communication system at two large medical centers. Subjects with a history of mild-to-moderate trauma were selected from the emergency departments of both hospitals from January to June 2019. Data on the presence of SP and OT, the side of the foot that was evaluated, sex, and age were recorded. The prevalence of SP and OT was 16.7 % and 9.3 %, respectively, in the Turkish population. The prevalence of SP was significantly higher in men (20.3 %) than in women (12.7 %) (p = 0.001). The prevalence of OT was also significantly higher in men (13.7 %) than in women (4.3 %) (p = 0.000). The SP and OT were found in 17 % and 9.9 % of the right feet, respectively, and 16.4 % and 8.6 % of the left feet, respectively, with no statistical difference. Approximately one-fourth of the Turkish population had SP or OT, which made them susceptible to posterior ankle impingement syndrome. The prevalence of SP was higher than that of OT, and both were more common in men than in women.
RESUMEN: El proceso de Stieda (Stieda process) (SP) y el Os trigonum (OT) son factores de riesgo primarios para el síndrome de pinzamiento del tobillo posterior. El objetivo de este estudio fue determinar la prevalencia del tubérculo lateral alargado del proceso talar posterior (SP) y OT en sujetos turcos mediante radiografías laterales de tobillo. Se evaluaron retrospectivamente 1088 radiografías de tobillo con vista lateral, utilizando un sistema de archivo y comunicación de imágenes en dos centros médicos importantes. Los sujetos con antecedentes de trauma leve a moderado fueron seleccionados en las unidades de urgencia de ambos hospitales de enero a junio de 2019. Se registraron datos sobre la presencia de SP y OT, el lado del pie que se evaluó, el sexo y la edad. La prevalencia de SP y OT fue de 16,7 % y 9,3 %, respectivamente, en la población turca. La prevalencia de SP fue significativamente mayor en hombres (20,3 %) que en mujeres (12,7 %) (p = 0,001). La prevalencia de OT también fue significativamente mayor en hombres (13,7 %) que en mujeres (4,3 %) (p = 0,000). El SP y OT se encontraron en 17 % y 9,9 % de los pies derechos, respectivamente, y 16,4 % y 8,6 % de los pies izquierdos, respectivamente, sin diferencia estadística. Aproximadamente un cuarto de la población turca tenía SP u OT, lo que los hizo susceptibles al síndrome de pinzamiento del tobillo posterior. La prevalencia de SP fue mayor que la de OT, y ambos fueron más comun en hombres que en mujeres.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ankle/abnormalities , Ankle/diagnostic imaging , Turkey , Radiography , Talus , Prevalence , Retrospective StudiesABSTRACT
El tubérculo lateral del proceso posterior del talo se fusiona generalmente con el cuerpo de este hueso, sin embargo, debido al estrés (flexión plantar forzada) aplicado durante los años de la adolescencia o cuando un centro osificado parcialmente e incluso totalmente osificado se fractura, se provoca una falta de unión, dando lugar a un hueso accesorio denominado Os trigonum (OT). En algunos casos puede producirse el síndrome os trigonum o síndrome de pinzamiento posterior, el cual se caracteriza por un dolor agudo o crónico de la región posterior del tobillo. Basado en lo anterior, se realizó un estudio retrospectivo entre el período de Agosto de 2017 a Mayo de 2018, en el cual se analizaron radiografías bilaterales de 205 pacientes concurrentes al Hospital Hernán Henríquez Aravena de Temuco, Chile. De la población estudiada, 154 fueron de sexo femenino y 51 de sexo masculino cuyas edades fluctuaron entre los 15 y 85 años, Las proyecciones radiológicas utilizadas fueron de pie lateral, tobillo lateral o calcáneo lateral, para así para determinar la prevalencia de OT y contribuir acerca de su distribución en pie derecho e izquierdo y aparición según sexo y edad. Del total de la muestra, se encontraron 24 individuos que presentaban OT (11,7 %) de los cuales 18 (75 %) correspondían al sexo femenino y 6 (25 %) al sexo masculino. Además se realizaron mediciones del largo y ancho del OT. Los datos obtenidos son una contribución al conocimiento de los huesos accesorios del pie en la población chilena.
The lateral tubercle of the posterior process of the talus is generally fused with the body of this bone, however, due to stress (forced plantar flexion) applied during the adolescent years. Also, when a partially ossified and even fully ossified center fractures, it causes a lack of union, giving rise to an accessory bone called Os trigonum (OT). In some cases Os trigonum syndrome or posterior impingement syndrome may occur, which is characterized by acute or chronic pain in the posterior region of the ankle. Based on the above, a retrospective study was conducted between August 2017 and May 2018, in which bilateral radiographs of 205 patients attending the Hernán Henríquez Aravena Hospital of Temuco were analyzed. Of the population studied, 154 were female and 51 were male, whose ages fluctuated between 15 and 85 years. The radiological projections used were lateral foot, lateral ankle and calcaneus lateral, to determine the prevalence of OT and provide information about its distribution in right and left foot and appearance according to sex and age. From the total sample, 24 individuals were found who had OT (11.7 %) of which 18 (75 %) corresponded to the female sex and 6 (25 %) to the male sex. In addition, measurements of the length and width of the OT were made. The data obtained is a contribution to the knowledge of the accessory bones of the foot in the Chilean population.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Talus/pathology , Talus/diagnostic imaging , Chile , Prevalence , Retrospective Studies , Age and Sex DistributionABSTRACT
El Os trigonum (OT) y el Proceso de Stieda (PS), corresponden a la osificación separada o extensiva del tubérculo lateral de la cara posterior del talus (TA), respectivamente. Son indicados como factores causales del Síndrome del Impacto Posterior del Tobillo (SIPT), disturbio, agudo o crónico, con dolor en la región posterior del tobillo a los movimientos del pie. El objetivo fue analizar la importancia morfológica de la presencia del OT y/o PS y su posible relación con el SIPT. Fueron utilizados 80 TA secos. La morfometría del TA y del Tubérculo Lateral del TA (TL) fueron calculadas y expresas como: LTA = largo total del TA; ATA = ancho total del TA; LTL/LPS = largo total de TL/PS; ETL = espesor total de TL/PS. Los análisis mostraron valores de LTA: 55,22 (+/-4,16) mm; ATA: 39,51 (+/-2,46) mm; LTL/LPS: 8,06 mm (+/-2,14) y ETL: 8,46 (+/-1,01) mm. Nuestros resultados ofrecen informaciones no encontradas en la literatura especializada y ayudan en el diagnóstico y tratamiento del SIPT.
Os Trigonum (OT) and Stieda Process (SP), separate or extensive ossification of the lateral tubercule of posterior face of Talus (TA), respectively, are indicative of causal factors of the Posterior Impingement Syndrome of The Ankle (PISA) - disturbance, sharp or chronic pain, with pain in the posterior region of the ankle caused by foot movements. The objective of this study was to analyze the morphological importance of the presence of OT and or SP and the possible relationship with PISA for which we used 80 dry TA. The morphometry of TA and Lateral Tubercule of TA (LT) were calculated and expressed as mean: LTA= total length of TA; WTA= total width of TA; LLT/LPS= total length of LT/SP; TLT= total thickness of LT/SP. The measures were LTA: 55.22 (+/-4.16) mm; WTA: 39.51 (+/-2.46) mm; LLT/LPS: 8.06 (+/-2.14) mm; TLT: 8.46 (+/-1.01) mm. Our results provide useful information not found in the specialized literature and are of assistance in the diagnosis and treatment of PISA.