An ex vivo sequential ligament transection model of flatfoot.

BACKGROUND: The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distribution from ligaments critical for maintaining load distribution. A serial transection of ligaments may provide insight into changes in pressure distribution under the foot to identify a potential combination of ligaments that may be involved in early deformities. METHODS: Specimens were loaded using a custom designed axial and tendon loading system. Plantar pressure data for the forefoot and hindfoot were recorded before and after six sequential ligament complex transections. FINDINGS: Sectioning the plantar fascia (first) and short/long plantar ligaments (second) failed to generate appreciable differences in load distribution. Dividing the spring ligament (third) led to changes in hindfoot load distribution with a shift towards the lateral column indicative of hindfoot valgus angulation. All subsequent conditions resulted in similar patterns in hindfoot plantar load distribution. An anterior shift in the center of pressure only occurred after transection of all six ligament complexes. INTERPRETATION: Loss of the plantar fascia and short/long plantar ligaments are not critical in maintaining plantar load distribution or contact area. However, the additional loss of the spring ligament caused notable changes in hindfoot load distribution, indicating the combination of these three ligament complexes is particularly critical for preventing peritalar subluxation. Minimal changes in load distribution occurred when performing additional transections to reach a complete flatfoot deformity.

Contribution of ligaments to intersegmental stability following type II odontoid fracture.

Purpose: Management of Anderson and D'Alonzo type II odontoid fractures continues to be controversial despite extensive research and increasing prevalence. To the authors' knowledge, the three odontoid ligaments, the alar ligament, the vertical portion of the cruciate ligament, and the transverse ligament, have not been biomechanically examined in type II odontoid fracture in spite of their potential significance in management. Therefore, this study aims to explore the intersegmental rotations of the craniovertebral junction following Anderson and D'Alonzo type II odontoid fracture and various combinations of ligament ruptures. Methods: A validated C0-C7 cervical spine finite element model was employed to address the research objectives. The model was subjected to flexion-extension, lateral bending, and axial rotation under eight distinct injury conditions apart from the intact state. Prescribed rotations were applied to the top of the cranium while the C7 inferior surface was fixed. Rotation-moment data were retrieved from the model. Results: Type II odontoid fracture caused mixed forms of instability considering flexion-extension. In lateral bending, the fracture alone did not have a significant effect, whereas the disruption of ligaments led to moderate rotation increments. Notably, in axial rotation, the fracture was the most crucial factor for stability. Conclusions: Overall, type II odontoid fracture was found to be the main destabilizing element. Nonetheless, the vertical cruciate and the transverse ligament played a modest role in stabilization. The alar ligament provided minimal or no stability. Furthermore, instances were observed where both the vertical cruciate and the transverse ligament were necessary to prevent more instability.

Effect of generalized ligamentous hyperlaxity related of quality of life in the foot: a case controlled study

SUMMARY Generalized ligamentous hyperlaxity (GLH) has been shown to predispose an individual to a number of orthopaedic conditions. Little is known about how GLH affects people' foot health-related quality of life. This study analyses a sample of people with GLH and people without GLH with normalised reference values of the scores collected with regard to using the Foot Health Status Questionnaire (FSHQ). A total of 100 respondents with mean age of 22.69 ± 3.78 years old, who attended a health centre were classified as GLH (n = 50) or non-GLH (n = 50). The GLH was determined of the patients with and without GLH using assessment with Beighton tool and the scores on the FHSQ were compared. The control group recorded higher scores in the First Section for foot pain, foot function and general foot health, and lower scores in footwear. In the Second Section, they obtained higher scores in social capacity and lower scores in physical activity, vigour and general health. Differences between the two groups were evaluated through a t-test for independent samples, showing statistical significance (P<0.001). This study has detected measurable differences of association between GLH (Beighton score ≥4) with impaired quality of life related to foot health.

RESUMO A hiperlaxia ligamentosa generalizada (HLG) demonstrou predispor um indivíduo a várias condições ortopédicas. Pouco se sabe sobre como a HLG afeta a qualidade de vida relacionada à saúde do pé das pessoas. Este estudo analisa uma amostra de pessoas com HLG e pessoas sem HLG com valores de referência normalizados das pontuações coletadas no que diz respeito ao Foot Health Status Questionnaire (FSHQ). Um total de 100 informantes com média de idade de 22,69 ± 3,78 anos que eram atendidos em um centro de saúde foi classificado como HLG (n = 50) ou não HLG (n = 50). A HLG foi determinada com os pacientes com e sem HLG usando a ferramenta Beighton e os escores na FHSQ foram comparados. O grupo de controle registrou pontuações mais altas na primeira seção para a dor no pé, função do pé e saúde geral do pé, e menores pontuações no calçado. Na segunda seção obtiveram maiores escores em capacidade social e menores escores em atividade física, vigor e saúde geral. As diferenças entre os dois grupos foram avaliadas por meio de um teste t para amostras independentes, mostrando significância estatística (P<0,001). Este estudo detectou diferenças mensuráveis de associação entre HLG (pontuação de Beighton≥4) com deterioração da qualidade de vida relacionada à saúde dos pés.

Tratamiento del dolor orofacial en pacientes con síndrome del ligamento estilomandibular (síndrome de Ernest) / Treatment of orofacial pain in patients with stylomandibular ligament syndrome (Ernest Syndrome)

Introducción: El síndrome de Ernest se define como una alteración del ligamento estilomandibular, caracterizado por la presencia de dolor en la región preauricular y en el ángulo mandibular, irradiado al cuello, el hombro y el ojo del mismo lado, asociado a dolor durante la palpación del ligamento estilomandibular. El objetivo es presentar las características clínicas, el tratamiento y la evolución de una serie de pacientes con el síndrome de Ernest. Métodos: Se realizó un estudio clínico, observacional, retrospectivo, entre los años 1998 y 2008. Se recogieron todos los datos con respecto a la edad, el sexo, eltiempo de evolución y las característicasdeldolor.Atodos lospacientes seles infiltró40mgdeacetónidodetriamcinolonaen la inserción mandibular del ligamento estilomandibular. Resultados: Se incluyó a 6 pacientes. La edad media fue de 40,3 anos (rango 35-51). El 100% eran mujeres. Cuatro de las 6 pacientes recibieron tratamientos odontológicos prolongados el mes previo a la aparición del dolor. El tiempo de evolución medio antes de la primera visita fue de 23 meses. Tras eltratamiento realizado, se obtuvo una resolución completa de todos los pacientes, con un periodo de seguimiento mínimo de 12 meses. Conclusiones: Se han analizado las características clínicas del dolor, el tratamiento recibido y la evolución de 6 pacientes con el síndrome de Ernest. Es importante realizar un correcto diagnóstico para poder establecer el tratamiento correcto. Creemos que esta enfermedad es más prevalente de lo encontrado en la literatura, pudiéndose confundir con otros dolores orofaciales (AU)

Introduction: Ernest syndrome involves the stylomandibular ligament. It is characterised by pain in the preauricular area and mandibular angle, radiating to the neck, shoulder, and eye on the same side, and associated with pain during palpation of that ligament. The purpose of this study is to describe the clinical characteristics, treatment, and course of the disease in a series of patients with Ernest syndrome. Methods: Retrospective observational study covering the period from 1998 to 2008. We recorded patients’ age, sex, duration of the disorder, and pain characteristics. All patients were injected with 40mg triamcinolone acetonide atthe mandibularinsertion ofthe stylomandibular ligament. Results: The study included a total of 6 patients. Mean age was 40.3 years (range, 35-51). All of the subjects were women. Four patients had undergone lengthy dental treatments in the month priorto onset ofthe pain. The mean time between pain onset and first consultation was 23 months. The syndrome resolved completely in all cases after treatment, with a minimum follow-up period of 12 months. Conclusions: We analysed the clinical characteristics, treatment, and course of disease in 6 patients with Ernest syndrome. Correct diagnosis is the key to being able to provide proper treatment. This disorder is sometimes confused with other types of orofacial pain, and may therefore be more prevalent than the literature would indicate (AU)

Ossification of the stylohyoid ligament and ‘Eagle’s’ syndrome

‘Eagle’s’ syndrome is a rare condition in which an ossified stylohyoid ligament may endanger neural and vascular structures in the neck (Eagle, 1949, 1962; Rechtweg et al., 1998; Rodriguez-Vazquez et al., 2006; Chuang et al., 2007). Compression of one or other of these structures may give rise to symptoms including unilateral neck pain, dysphagia, otalgia and tinnitus (Kaufman et al., 1970; Omnell et al., 1998; Basekim et al., 2005; Ramadan et al., 2007; Yagci et al., 2007; Ramadan et al., 2010. Computer Tomography (CT) scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years (mean age 35.93 ± 24.15) who were admitted for medico-legal death investigation to the Victorian Institute of Forensic Medicine (VIFM) in Melbourne, Australia were examined. Ossification of the ligament was observed to occur in parts, the superior part at its attachment to the styloid process of the temporal bone being the most common. Complete ossification was not seen. Ligament ossification increased with age although there were no sex differences. In some cases there appeared to be a pseudoarthrosis along the course of the ligament. While the study did not examine the anatomical relationship to neurovascular structures it is apparent that the stylohyoid ligament may undergo almost complete ossification and could compress vital neck structures (AU)

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Análisis de la longitud del ligamento estilohiodeo mediante sistema cone beam / Analysis of the stylohyoid ligament's in cone beam images

Introducción y Objetivo: La elongación y/o osificación del ligamento estilohioideo es una patologíapoco conocida, con un diagnóstico difícil de establecer. El propósito del presente estudio fuerealizar un análisis retrospectivo de exámenes para evaluar la presencia de variaciones en la longitud del ligamento estilohiodeo, según edad y género, mediante un Sistema de tomografía de alta resolución Cone Beam debido a su gran confiabilidad dimensional. Materiales y Métodos: La muestra consistió en 82 exámenes imagenológicos, los cuales fueron obtenidos con fines de estudios Ortodóncicos, de Implantología o de Diagnóstico general, durante el año 2008-2009. Se realizó el análisis retrospectivo de la muestra, y se clasificó según edad, género, y se individualizó el análisis cuantitativo tridimensional de los procesos estilohioideos. Resultados: El análisis realizado no mostró diferencias significativas en las variables relacionadas con el género, sin embargo en los pacientes mayores de 50 años, hubo un incremento importante en la longitud del ligamento estilohioideo. Conclusión: Los resultados obtenidos difieren con los resultados de trabajos anteriores analizados mediante ortopantomografía. Esto se explicaría por la gran sensibilidad diagnóstica del método utilizado.

Introduction and Objetive: This paper analyzes the existence of variations in the length of the stylohyoid ligament, according to age a genre, by using the high resolution Cone Beam System. Materials and Methods: The research was based in a sample of 82 imagenology examinations taken during the period 2008-2009 for routine studies in orthodontics, implantology and general diagnosis. The sample was examined with 3D measurements of the styloid process considering aprevious classification by age a genre, to establish if there is difference through these variables. Results: We found no significant difference in the length of the stylohyoid ligament by genre. However, there is evidence of an increase of the lengths of the ligament in patients over 50 years old. Conclusion: Our findings differ from previous documentation by using less accurate systems like orthopantomography.

Principios básicos de la enfermedad de Kienböck: anatomía y vascularización del semilunar / Basic principles of Kienböck´s disease: anatomy and vascularization of the lunate

Objetivo: El propósito del estudio es investigar la vascularización y lasrelaciones anatómicas del semilunar. Se correlacionan los patronesde vascularización con la morfología del semilunar, la ruptura de losligamentos y el grado de artrosis. Los hallazgos obtenidos ayudan aapoyar o descartar algunas de las teorías etiopatogénicas.Material y Métodos: Estudiamos 24 extremidades superiores decadáver mediante la técnica de Spalteholtz e investigamos la circulaciónextra e intraósea en el semilunar. Evaluamos la incidencia ydistribución de distintas características anatómicas, artrosis y lesionesde partes blandas.Resultados: La morfología del semilunar fue de 5 casos tipo I(20.8%), 18 casos tipo II (75%) y 1 caso tipo III (4.2%). El semilunarpresentaba una faceta articular para ganchoso en 11 casos (48.8%).El tamaño de esta faceta fue de 3 mm (rango, 3-6 mm). La artrosisse identificó con más frecuencia en el radio (88.2%) y en el semilunar(94.1%). El complejo fibrocartílago triangular (CFCT) estaba roto en el58.3%, el ligamento interóseo lunopiramidal (LILP) en el 20.8%, y elligamento interóseo escafolunar (LIEL) en el 54.2% de los carpos.Existe una correlación entre la artrosis del ganchoso y la faceta lunarpara el ganchoso (p= 0.027), así como, una correlación entre la rupturadel LIEL y la artrosis del escafoides (p= 0.002). Los vasosnutrientes entran en el semilunar por su polo dorsal y volar en todoslos especímenes. El arco radiocarpiano e intercarpiano dorsal nutre elsemilunar por un plexo que entra en éste por 1-3 foráminas. Las arteriolaspalmares entran en el semilunar a través de 2-6 foráminas yvan acompañadas de tres inserciones ligamentosas: ligamento radioescafolunarprofundo de Testut-Kuentz, ligamento radio-semilunarpiramidaly del ligamento cúbito-semilunar.Conclusiones: El semilunar tiene entradas vasculares dorsales yvolares en todos los especímenes. La suplencia vascular llega pordistintos ligamentos. El aporte vascular entra en el hueso a travésde foráminas que se encuentran en mayor número en la carillavolar que en la dorsal. En la etiopatogenia de la enfermedad deKienböck es posible que una lesión aguda o crónica, traumática ono-traumática pueda dañar los vasos que tienen estos ligamentos,en particular el ligamento radioescafolunar profundo de Testut-Kuentz, que debido a su estructura y localización, pueda tener unpapel relevante en la aparición de la necrosis del semilunar

Purpose: The purpose of this study was to assess the anatomyand vascularization of the lunate. We correlated vascularizationpatterns with lunate morphology, ligament tears andthe degree of arthrosis. The findings will be correlated with themajor existing theories of the cause of Kienböck´s disease.Material and Methods: We studied 24 cadaver upper limbsusing latex injection and the Spalteholz technique. We investigatedthe extra and intraosseous blood supply to the lunate.We evaluated the incidence and distribution of anatomic features,arthrosis, and soft tissue lesions.Results: The lunate morphology was 5 type I (20.8%), 18 type II(75%) and 1 type III (4.2%). The lunate was found to have aseparate facet for the hamate in 11 cases (45.8%). The mostcommon size of the facet was found to be 3 mm (range, 3-6mm). Arthrosis was identified most frequently in radius (88.2%)and lunate (94.1%). The triangular fibrocartilage complex (TFCC)was found torn in 58.3%, the lunotriquetral interosseous ligament(LTIL) was torn in 20.8% and the scapholunate interosseous ligament(SLIL) was torn in 54.2% of the wrists. There was a correlationbetween the presence of arthrosis at the proximal pole of thehamate and the presence of a lunate facet (p= 0.027) and acorrelation between the presence of a tear in the SLIL and arthrosisin the scaphoid (p= 0.002). The nutrient vessels entered thelunate through the dorsal and volar poles in all the specimens.The dorsal intercarpal and radiocarpal arches supply blood to thelunate from a plexus of vessels located directly over the lunate´sdorsal pole. Vessels entered the dorsal aspect of the lunatethrough one to three foramina. Two to five nutrient vessels wereobserved entering the volar pole through various ligament insertions,including the ligament of Testut-Kuentz (radioscapholunateligament) and the radiolunate triquetrum ligament (or dorsoradialcarpal ligament) and ulnar lunate triquetral ligament.Conclusions: The lunate had consistent dorsal and palmararteries entering the bone in all the specimens. The bloodsupply and foramina number is greater in the volar pole of thelunate than the dorsal pole. The lunate blood supply comesfrom different ligaments. In the aetiopathogeny ofKienböck’disease it is possible that an acute or chronic, traumaticor non-traumatic lesion of the vessel bearing ligaments,particularly because of their structure and the location of theradioscapholunate ligament of Testut-Kuentz, may have animportant role in the appearance of lunate necrosis

Osificación del ligamento estilohioideo (Síndrome de Eagle): presentación de un caso / Ossification of the stylohyoid ligament (Eagle's Sindrome): presentation of 1 case

Se presenta el caso de una paciente femenina de 41 años con osoficación de los ligamentos estilohioideos (síndrome de Eagle), que simulaba dolor en la articulación témporo-mandibular. Esta es una patología que se presenta entre el 1 - 4 por ciento de la población en general, pero solo un número muy pequeño de estos se llegan a reconoer, ya que puede ser asintomáticos o presentar diversas manifestaciones clínicas. Se hace una revisión del tema