Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study.

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

Skeletal development of hallucal tarsometatarsal joint curvature and angulation in extant apes and modern humans.

The medial cuneiform, namely the curvature and angulation of its distal facet with metatarsal 1, is crucial as a stabilizer in bipedal locomotion and an axis upon which the great toe medially deviates during arboreal locomotion in extant apes. Previous work has shown that facet curvature and angulation in adult dry-bone specimens can distinguish African apes from Homo, and can even distinguish among species of Gorilla. This study provides the first ontogenetic assessment of medial cuneiform curvature and angulation in juvenile (n = 68) and adult specimens (n = 102) using computed tomography in humans and extant ape specimens, including Pongo. Our data find that modern human juveniles initially have a convex and slightly medially oriented osseous surface of the developing medial cuneiform distal facet that flattens and becomes more distally oriented with age. The same pattern (though of a different magnitude) occurs developmentally in the chimpanzee medial cuneiform, but not in Gorilla or Pongo, whose medial cuneiform facet angulation remains unchanged ontogenetically. These data suggest that the medial cuneiform ossifies in a distinguishable pattern between Pongo, Gorilla, Pan, and Homo, which may in part be due to subtle differences in the loading environment at the hallucal tarsometatarsal joint-a finding that has important implications for interpreting fossil medial cuneiforms.

Standard growth of the foot arch in childhood and adolescence--derived from the measurement results of 10,155 children.

BACKGROUND: The definition of flatfoot remains analytically vague. Toward the purpose of establishing the standard values of the foot length and arch height in childhood and adolescence, large-scale measurement and investigation of the foot arch were conducted using a three-dimensional foot-measuring device. METHODS: Measurements of foot structure were performed on 5311 boys and 4844 girls, for a total of 20,310 ft. of 10,155 children aged from 6 to 18 years during the 2006-2008 year period. The foot length (FL) and the navicular height (NH) were measured, and the arch height ratio (AHR (%)=NH×100/FL) was calculated. RESULTS: The FL in boys showed an extension from the age of 6 to 14 and nearly reached a plateau at 14 years old. In girls, the extension was observed from the age of 6 to 13, and the FL came to a plateau at 13 years old. The NH in boys increased from the age of 6 to 13. In girls, the NH increased from the age of 8 to 13. The AHR, presented a normal distribution, and no differences were observed in the distribution for all ages in boys and girls. In boys, the AHR was almost flat until 11 years old, but elevated in the 11-13 year age period. In girls, the AHR was almost flat until 10 years old, but elevated in the 10-12 year age period. CONCLUSIONS: We are certain that the data demonstrating the normal growth of the foot contribute to the diagnosis and treatment of the failure of the foot to thrive.

Medial malleolar screw versus tension-band plate hemiepiphysiodesis for ankle valgus in the skeletally immature.

BACKGROUND: Ankle valgus is frequently encountered in skeletally immature patients in association with a variety of musculoskeletal disorders. Guided growth with temporary medial malleolar transphyseal screw (MMS) hemiepiphysiodesis is an established surgical treatment capable of correcting the angular deformity, but is often complicated by symptomatic screw head prominence and difficult hardware removal. Tension-band plate (TBP) hemiepiphysiodesis has recently been advocated as an alternative; however, the relative efficacy of these 2 techniques has not been directly investigated. Thus, the purpose of this study was to compare MMS and TBP in treatment of pediatric ankle valgus deformity. METHODS: Medical records and radiographs of all patients undergoing distal tibial medial hemiepiphysiodesis for ankle valgus between January 1, 2005 and November 1, 2010 at a pediatric orthopaedic specialty hospital were retrospectively reviewed. Radiographs obtained preoperatively and at 6-month intervals postoperatively were reviewed and the tibiotalar angle was measured. Patient age, sex, underlying diagnosis, concurrent surgical procedures, surgical and postoperative complications, and the presence or absence of symptomatic hardware complaints were documented. RESULTS: Sixty ankles in 42 patients met the inclusion criteria, with adequate radiographs and minimum postoperative follow-up of 12 months (mean: 34 mo). Thirty-five ankles were treated with MMS, and 25 with TBP. Good mean correction of the tibiotalar angle was achieved in both groups (MMS: pre-77.1 degrees to post-87.8 degrees over 25.2 mo; TBP: pre-81.3 to post-87.6 over 20.0 mo). The mean rate of correction was faster in ankles treated with MMS than TBP, but differences did not reach statistical significance (0.55 vs. 0.36 degrees/mo, respectively; P=0.057). Complications included 6 hardware-related surgical complications in MMS ankles (17.1%) and 1 in TBP ankles (4.0%). The incidence of symptomatic hardware complaints was low in both groups (MMS, 5.7%; TBP, 0%). CONCLUSIONS: Both MMS and TBP techniques can result in successful correction of ankle valgus in the growing child. Although the rate of deformity correction may be faster with MMS, TBP seems to be associated with fewer hardware-related complications. This information may aid the clinician in selecting the surgical option most appropriate for each individual patient. LEVEL OF EVIDENCE: Level II-retrospective study.

Improvement in growth after 1 year of growth hormone therapy in well-nourished infants with growth retardation secondary to chronic renal failure: results of a multicenter, controlled, randomized, open clinical trial.

BACKGROUND AND OBJECTIVES: Our aim was to evaluate the growth-promoting effect of growth hormone (GH) treatment in infants with chronic renal failure (CRF) and persistent growth retardation despite adequate nutritional and metabolic management. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study design included randomized, parallel groups in an open, multicenter trial comparing GH (0.33 mg/kg per wk) with nontreatment with GH during 12 months. Sixteen infants who had growth retardation, were aged 12+/-3 months, had CRF (GFR

Growth and development of tarsal and metatarsal bones in successfully treated congenital idiopathic clubfoot: early radiographic study.

Fifteen cases of unilateral clubfoot treated according to Ponseti's technique had the talocalcaneal angles on the anteroposterior and lateral views and the size of the talus, calcaneus, I-V metatarsus measured on radiographs of both feet that were taken at a mean age of 15.2 months (range 8-23). The measurements of talocalcaneal angles and size of the talus, calcaneus, and I, II, and III metatarsi were significantly smaller on the affected side, whereas the values for the IV and V metatarsi were similar on both sides. Clubfoot deformity involves all structures of the foot, but intrinsic compressive forces on the small hindfoot bones induce measurable reduction in their size and spatial orientation. This effect is seen early on the medial but not the lateral long tubular forefoot bones.

Developmental basis of limb homology in lizards.

Shubin and Alberch (Evol Biol 1986;20:319-387) proposed a scheme of tetrapod limb development based on cartilage morphogenesis that provides the arguments to interpret the homologies of skeletal elements and sets the basis to explain limb specialization through later developmental modification. Morphogenetic evidence emerged from the study of some reptiles, but the availability of data for lizards is limited. Here, the study of adult skeletal variation in 41 lizard taxa and ontogeny in species of Liolaemus and Tupinambis attempts to fill in this gap and provides supporting evidence for the Shubin-Alberch scheme. Six questions are explored. Is there an intermedium in the carpus? Are there two centralia in the carpus? Is there homology among proximal tarsalia of reptiles? Does digit V belong to the digital arch? Is the pisiform an element of the autopodium plan? And should the ossification processes be similar to cartilage morphogenesis? We found the following answers. Some taxa exhibit an ossified element that could represent an intermedium. There is one centrale in the carpus. Development of proximal tarsalia seems to be equivalent with that observed among reptiles. Digit V could arise from the digital arch. Pisiform does not arise as part of the limb plan. And different patterns of ossification occur following a single and conservative cartilaginous configuration. Lizard limb development shows an early pattern common to other reptiles with clear primary axis and digital arch. The pattern then becomes lizard-specific with specialization involving some reduction in prechondrogenic elements.

Early skeletal development in Talpa europaea, the common European mole.

An ontogenetic series of 22 cleared and double-stained prenatal specimens was used to study the sequence of ossification of selected postcranial skeletal elements of Talpa europaea. Results were compared with nine other therian mammals, with Alligator, Chelydra, and Lacerta as outgroups. Using the event-pairing method, shifts in the onset of ossification in T. europaea, Sus, and Homo were identified. In T. europaea, the ossification of the cervical vertebrae starts before the metatarsals. In Homo and Sus, the tarsals ossify before the pubic bone. These shifts in the sequence of ossification are unique among the mammals examined, whereas many other changes, characterising monophyletic groups and/or evolving convergently, were also identified. Particular attention was given to some peculiar calcified elements of the hand in T. europaea, which were identified as accessory ;sesamoid bones', and do not display a chondrified precursor. They start to calcify before all others of the hand and later fuse. They appear in all fingers and function as reinforcement for the distal phalanges, most likely as an adaptation for burrowing. The development of the sesamoid bones was examined using histological sections and macerated adults.

Comparison of the navicular region of newborn foals and adult horses by magnetic resonance imaging.

Magnetic resonance imaging (MRI) was tested for evaluation of the soft tissue structures of the equine digit in 16 limbs, derived from three adult warmblood horses and two newborn warmblood foals. The following measuring sequences were used in sagittal, transversal and coronal planes: spin echo, gradient echo, inversion recovery. The images were made with a 1.5 Tesla Siemens scanner in a CP-Helmholtz circular coil. To compare the visualization of the same tissue structures in adult and in newborn cases the limbs were imaged with the routinely used MRI sequences that are used for mature tissues. In newborn foals the bursa podotrochlearis could not be determined with the used sequences. For both the adult and newborn limbs the most visualization of the same tissue structures including the fluid spaces and growth plates were taken by the inversion recovery sequence. T2 sequence was very informative in adult cases but moderately in newborn foals.

The acrophysis: a unifying concept for understanding enchondral bone growth and its disorders. II. Abnormal growth.

In order to discuss and illustrate the effects common to normal and abnormal enchondral bone at the physes and at all other growth plates of the developing child, the term "acrophysis" was proposed. Acrophyses include the growth plates of secondary growth centers including carpals and tarsals and apophyses, and the growth plates at the nonphyseal ends of small tubular bones. Abnormalities at acrophyseal sites are analogous to those at the physeal growth plates and their metaphyses. For example, changes relating to the zone of provisional calcification (ZPC) are often important to the demonstration of such similarities. Lead lines were an early example of the concept of analogy from abnormality due to physeal and to acrophyseal disturbance. The ZPC is a key factor in understanding patterns of rickets and its healing. Examples (including hypothyroidism, scurvy and other osteoporosis, Ollier disease, achondroplasia, and osteopetrosis, as well as the family of frostbite, Kashin-Beck disease, and rat bite fever) illustrate the acrophysis principle and in turn their manifestations are explained by that principle.

The acrophysis: a unifying concept for enchondral bone growth and its disorders. I. Normal growth.

In order to discuss and illustrate the common effects on normal and abnormal enchondral bone at the physes and at all other growth plates of the developing child, the term "acrophysis" is proposed. Acrophyses include the growth plates of secondary growth centers including carpals and tarsals and apophyses, and the growth plates at the non-physeal ends of small tubular bones. The last layer of development of both physes and acrophysis is the cartilaginous zone of provisional calcification (ZPC). The enchondral bone abutting the ZPC shares similar properties at physes and acrophyses, including the relatively lucent metaphyseal bands of many normal infants at several weeks of age. The bone-in-bone pattern of the normal vertebral bodies and bands of demineralization of the tarsal bones just under the ZPC are the equivalent of those bands. The growth arrest/recovery lines of metaphyses similarly have equivalent lines in growth centers and other acrophyseal sites. Nearly the same effects can also be anticipated from the relatively similar growth plate at the cartilaginous cap of benign exostoses ("paraphysis"). The companion article will explore abnormalities at acrophyseal sites, including metabolic bone disease and dysplasias.

The radiographic development of the distal and proximal double contours of the equine navicular bone on dorsoproximal-palmarodistal oblique (upright pedal) radiographs, from age 1 to 11 months.

The aim of this study was to monitor the postnatal radiographic development of the proximal and distal double contours and the modelling of the shape of the proximal articular border. In mature horses, the proximal and distal contours of the navicular bone on dorsopalmar dorsoproximal-palmarodistal oblique (upright pedal) radiographs are commonly visualised as 2 lines, one being the articular border and the second representing the border of the cortex facing the deep digital flexor tendon (flexor border). The shape of the proximal articular border may be concave, undulating, straight or convex in the mature animal. These shapes have been found to be hereditary and to constitute a predisposing factor in the pathogenesis of navicular disease. This predisposing role may result from a shape dependent distribution of the biomechanical forces exerted on this region. There is no agreement in the literature with respect to the moment when the navicular bone takes its mature radiographic appearance. Upright pedal radiographs of the left front foot of 19 Dutch Warmblood foals were made at age 1 month and subsequently at intervals of 4 weeks, until the age of 11 months. The distal double contour developed soon after birth and the radiographic visibility of the articular border improved from ill-defined at 1 or 2 months to clear manifestation at 3 or 4 months. The proximal double contour developed later. The articular border became usually visible at age 3 or 4 months and was clearly visible from age 9 months. The mature shape of the proximal articular border usually became recognisable from age 7 months and was always obvious between 9 and 11 months. This development was associated with a gradual modelling of the lateral and medial extremities of the navicular bone. It was concluded that the navicular bone adopts its mature radiological appearance during the first year postpartum. Considering this early manifestation of the mature shape of the proximal articular border and its previously demonstrated inheritance, a force-dependent development of this shape, as predicted by the trajectional theory/Wolffs law, is improbable. The predisposing role of this shape in the pathogenesis of navicular disease may therefore be explained by a shape-dependent distribution of the biomechanical forces exerted on the navicular bone. Considering the potential application of these findings, from age 1 year shape determination enables identification of the individual and breed susceptibility for the development of navicular disease.

An MRI study of the effect of treadmill training on bone morphology of the central and third tarsal bones of young thoroughbred horses.

Training results in marked modelling of the subchondral bone of the carpus, but the effect of training on the subchondral bone of the distal tarsal joints is unknown. The aim of this study was to determine whether training influenced modelling of the third and central tarsal bones in Thoroughbred horses. Twelve untrained Thoroughbred horses were divided into 2 groups. Group 1 underwent a 19 week progressive training regimen on a high speed treadmill. Group 2 were walked for 40 min daily. Images of left tarsi were obtained by magnetic resonance imaging (MRI) with a 0.5 Tesla superconducting magnet using a spin echo sequence. Sagittal and oblique sagittal slices were made perpendicular to the articular surfaces of the intertarsal joints and were analysed using image analysis software to measure the proportion of dense subchondral bone in the dorsal facet of each bone. Mean +/- s.d. percentage area of dense subchondral bone in the dorsal facet of the central tarsal bone in Group 1 was 47 +/- 8 medially, 46 +/- 4 sagitally and 50 +/- 11 dorsolaterally, whereas in Group 2 it was 39 +/- 16 medially, 43 +/- 8 sagitally and 53 +/- 7 dorsolaterally. For the third tarsal bone mean +/- s.d. percentage area of dense subchondral bone in Group 1 was 32 +/- 10 medially, 39 +/- 11 sagitally and 44 +/- 8 dorsolaterally, whereas in Group 2 it was 28 +/- 8 medially, 37 +/- 6 sagitally and 41 +/- 9 dorsolaterally. There was no significant difference in percentage area of dense subchondral bone between the trained and untrained horses. An effect of treadmill training of Thoroughbred horses on modelling of the central and third tarsal bones could not be demonstrated.

Appearance of ossification centers of the lower arm, wrist, lower leg, and ankle in immature orangutans and chimpanzees with an assessment of the relationship of ossification to dental development.

This study examines the appearance of the secondary ossification centers in the lower arms, wrists, lower legs, and ankles of a cross-sectional sample of 20 infant orangutans and chimpanzees (15 of known age). The number of tarsal and carpal centers is analyzed relative to the degree of M1 development and the weight of individual animals. Variation in the appearance of these ossification centers is discussed relative to these variables and others. In addition, a sequence of appearance is established for the carpal and tarsal ossification centers in the orangutan and data is presented on the status of these centers in a fetal and newborn gorilla. Study results indicate that 1) there is variation in the number of secondary epiphyses present in animals of similar ages; 2) tarsal ossification is completed prior to carpal ossification in the orangutan; 3) there are indications of a relationship between weight and the number of ossification centers present in animals of similar age; and 4) there appears to be no evidence of specific relationships between carpal and tarsal development and M1 development.

Morphological and biochemical effects of strenuous exercise on immature long bones.

To determine the effects of intense exercise on the growth of long bones in immature animals, young male white leghorn chickens were run five days per week starting at four weeks of age on motor-driven treadmills. Work intensity was determined on the basis of maximal oxygen consumption (VO2 max) with the exercise intensity maintained at 70-80 percent VO2 max. Young animals ran continuously for 30 minutes, older animals 45 to 60 minutes each day. Runners and controls (10 animals per group) were sacrificed at 8, 12, 14 and 20 weeks of age. The lengths of the femurs and tibiotarsus were significantly stunted at 8-, 12- and 14 weeks in the runners but had nearly recovered at 20 weeks of age. Both bones also demonstrated significantly decreased total cross-sectional areas in 8-, 12- and 14 week-old runners as well as decreased cortical cross-sectional areas. The tibiotarsus also remained significantly smaller in the 20-week-old runners, but the femur had recovered in terms of radial growth. Intermolecular pyridinoline collagen crosslinks were identical in amount in the two groups with the femur collagen significantly less cross-linked than the tibiotarsus. The delayed growth of the exercised avian young bone is consistent with data obtained from children and young mammalian models. The osteogenic response to exercise that produces an increased bone mass in adult tissue appears either suppressed or overcome in young avian bone indicating that it may be erroneous to assume that data obtained from adult tissue are also applicable to young growing bone.

Relationship between the ossification center and cartilaginous anlage in the normal hindfoot in children: study with MR imaging.

OBJECTIVE: Although many reports have documented when ossification centers can first be visualized on radiographs, few studies have evaluated the position of the ossification center within its cartilaginous anlage. In the skeletally immature child, the ossification centers of the tarsals are used to evaluate the positions of the tarsals and their interrelationships. It is convenient to assume that tarsal ossification begins in the center of its cartilaginous anlage and proceeds in a radial fashion; however, this may not be the case. Accordingly, we used MR imaging to evaluate the location of the ossification centers of the tarsals within their cartilaginous anlage in the mid and hindfoot in children. MATERIALS AND METHODS: MR studies of 69 feet in 40 children, 3 months to 7 years old (mean, 2.5 years), were reviewed retrospectively. The location of the ossification center within its cartilaginous anlage and the percentage of ossification of the cartilaginous anlagen of the talus, calcaneus, cuboid bone, and navicular bone were determined from coronal and sagittal images. In the talus, the difference between the orientation of the long axis of its ossification center and the long axis of its cartilaginous anlage was measured on coronal and sagittal images. RESULTS: Early talar ossification was centered on the neck of the talus; the proximal aspect of the bone ossified last. The long axis of the talar ossification center and the long axis of its cartilaginous anlage differed in orientation. Early calcaneal ossification was centered on the distal two thirds of the cartilaginous anlage of the calcaneus; the proximal aspect and the area of the subtalar joint ossified last. Early navicular ossification was centered on the central or lateral third of the navicular cartilaginous anlage; the medial aspect ossified last. The ossification center of the cuboid bone was in the middle of the cuboidal cartilaginous anlage. CONCLUSION: Our results show that early ossification in the talus, calcaneus, and navicular bones does not begin in the center of the bones' cartilaginous anlagen. The orientations of the long axis of the talar ossification center and the long mid axis of its cartilaginous anlage are different. Therefore, part of the changes in the alignment of the tarsals seen on radiographs with growth is due to ossification beginning and proceeding eccentrically within the cartilaginous anlage and not to a true change in the alignment of the tarsals. These data provide new information about the normal development of the child's hindfoot and midfoot.

[A case of bilateral isolated talonavicular synostosis in childhood--observations of tarsal joint function and functional adaptation of the proximal ankle joint]. / Ein Fall von beidseitiger isolierter talonavicularer Synostose im Kindesalter--Beobachtungen zur Mechanik des Tarsus und der funktionellen Adaptation des Oberen Sprunggelenkes.

A rare case of bilateral isolated coalition of the talonavicular joint with ball and socket ankle joint is presented. Range of motion of the subtalar joint and hindfoot mobility were measured intraoperatively. The following conclusions may be drawn on development and function of the ankle joint complex: Isolated talonavicular synostosis in the growing foot results in marked impairment of subtalar range of motion. The development of a ball and socket ankle joint may be caused thereby, if tarsal hypomobility becomes effective at an early stage of growth.

[The Z-shaped or serpentine foot in children and adolescents]. / Pied "en Z" ou "serpentin" chez l'enfant et l'adolescent.

Serpentine foot or Z-shaped foot, definite as varus of forefoot with valgus of heel, is a deformity which is advisable to separate from metatarsus varus in children. We have studied 55 serpentine feet of 31 children aged between 6 months and 13 1/2 years, observed in 20 years. We distinguished four grades of deformities. Treatment was orthopedic in 15 times, surgical in 29, with 50% of bad result, 11 feet which haven't had any treatment were in use to indicate evolution of the adductus. However, valgus of heel is transitory and secondary to forefoot rigidity, it always regressed but growth disturbance of tarsal bone occurred making lateral deviation. We insist on early radiographic diagnosis and treatment which is orthopaedic before first year of age, then surgical when first failed or in old children. It get release of metatarsal stiffness before 6 years of age, then in older we make osteotomy of 1 degree cuneiform and cuboid to correct bone deformity. Correction of hind foot valgus, realized in 24% of the surgical treatment, must be prohibited, it always made transverse tarsal instability.

[Causes of recurrence of congenital clubfoot in children and indications for surgical treatment]. / Prichiny retsidiva vrozhdennoi kosolaposti u detei i pokazaniia k khirurgicheskomu lecheniiu.

Unsatisfactory results of the conservative treatment of club foot deformity in 220 patients (346 feet) were analyzed. Data of roentgenograms in 86 patients enabled the authors to make a conclusion that an early cause of recurrent club foot is the delayed formation of nuclei of ossification of the navicular and I sphenoid bones, the later cause of the recurrent deformity is early synostosis of the epiphysis of the metatarsal bone. The importance of dispensary observation ad prophylactic measures after the treatment of congenital club foot is emphasized.