TL;DR: The clinical and radiological features of nine fatigue fractures developing along the soleal line of the posteromedial cortex of the proximal tibia of patients referred with the diagnosis of a probable malignant sarcoma of bone are described.
Abstract: The clinical and radiological features of nine fatigue fractures developing along the soleal line of the posteromedial cortex of the proximal tibia are described. Seven patients were referred with the diagnosis of a probable malignant sarcoma of bone. All nine patients were male and all but one were 18 years of age or less. Only two gave a history of a recent increase in physical activity. The plain radiographic findings consisted of an uninterrupted, lamellar, periosteal reaction arising medially and posteriorly in the proximal tibia with the fracture seen through the thickened posterior cortex. Bone scan revealed a fusiform focus of increased uptake in the posteromedial cortex of the tibia with varying degrees of activity in the adjacent metaphysis. Computed tomography, on a soft-tissue window, showed perifracture oedema and the absence of a soft-tissue mass. The attenuation of the underlying medulla was increased as a result of fibrosis and hyperaemia. On an extended window setting, both periosteal and endosteal callus was identified, maximal in the posteromedial tibia, and the fractures, multiple in two cases, were best demonstrated on a cortical window. Clinical and radiological features that differentiate a fatigue fracture of the tibia from a sarcoma are discussed.
TL;DR: A bilateral gastrocnemius tertius muscle and a unilateral accessory soleus muscle were encountered during the routine educational dissection studies and both had their origin from the lateral condyle of the femur.
Abstract: A bilateral gastrocnemius tertius muscle and a unilateral accessory soleus muscle were encountered during the routine educational dissection studies. The right gastrocnemius tertius muscle consisted of one belly, but the left one of two bellies. On the left side, the superficial belly of the gastrocnemius tertius muscle had its origin from an area just above the tendon of the plantaris muscle, the deep belly from the tendon of the plantaris muscle. The accessory soleus muscle originated from the posteromedial aspect of the tibia and soleal line of the tibia and inserted to the medial surface of the calcaneus. On the right side, the gastrocnemius tertius muscle had its origin from the lateral condyle of the femur, and inserted to the medial head of the gastrocnemius muscle. The co-existence of both gastrocnemius tertius and accessory soleus muscle has not, to our knowledge, been previously reported.
TL;DR: In this case, the diagnosis of popliteus tendon tenosynovitis was not made from magnetic resonance imaging findings, but was confirmed and successfully treated during arthroscopic examination.
Abstract: This case report highlights an unusual cause of anterolateral knee pain. The popliteus muscle arises from three origins--that is, the lateral femoral condyle, the fibula head, and the lateral meniscus--and inserts into the proximal tibia above the soleal line. It may be subjected to a number of pathologies including tenosynovitis, acute calcific tendonitis, rupture, and even avulsion. In this case, the diagnosis of popliteus tendon tenosynovitis was not made from magnetic resonance imaging findings, but was confirmed and successfully treated during arthroscopic examination.
TL;DR: This data could be useful as reference for surgical procedures of the lower limb and the location, the number of diaphyseal foramina, the distance and position of the foramina in relation to the length of the bone and the proximal epiphysis and the lateromedial diameter and anteroposterior diameter of theBone at the level of NF.
Abstract: The nutrient foramen (NF) of the tibia is located in the proximal third of its diaphysis. With the objective of complementing the information delivered by other authors, we investigated the location, the number of diaphyseal foramina, the distance and position of the foramina in relation to the length of the bone and the proximal epiphysis and the lateromedial diameter and anteroposterior diameter of the bone at the level of NF. For that purpose, we used 50 adult dry tibia of both sexes from the Anatomy department and museum of Manipal University. The mean length of the right tibia was 373mm, left tibia 387mm. Location of the NF was found over the soleal line in 4/26 (15.38%) left tibia and 3/24 (12.5%) right tibia, medial to the soleal line in 4/26 (15.38%) left tibia and 4/24 (16.66%) right tibia. In all the remaining cases, it was lateral to the soleal line. The NF was located in the upper third of the shaft in 23/26 (88.46%) left tibia and 22/24 (91.66%) right tibia, in the middle third 3/26 (11.53%) left tibia and 2/24 (8.33%) right tibia. Mean of maximum diameter of NF was 0.6mm in left tibia and 0.7mm in right tibia. Mean of lateromedial diameter at the level of NF was 28mm in left tibia and 26mm in right tibia. Mean of anteroposterior diameter of the shaft at the level of NF was 88mm on the left tibia and 92mm on the right tibia. Mean of the distance between NF and the highest point of intercondylar eminence was 130mm in left tibia and 134mm in right tibia. The FI of the right tibia was 35.92 and of the left tibia was 34. This data could be useful as reference for surgical procedures of the lower limb.
TL;DR: The present work should provide various disciplines of doctors, especially orthopedic surgeons with data that will help in various surgical procedures, especially to avoid damage to the nutrient vessels.
Abstract: The morphological knowledge of nutrient foramen is important, but there can be variations.
172 dry adult tibia of unknown age and sex were studied in the present observational, cross sectional study conducted in the departments of Anatomy and Orthopedics of a tertiary care medical college and hospital.
A single NF was observed in all tibia. 84 and 85 NF were directed downwards in the right and left tibia respectively. Location of nutrient foramen on the shaft was found as follows: for the right tibia, on the posterior, lateral and medial surfaces the number of cases were 85, 1 and 0 respectively; numbers for the same location for the left tibia were 83, 2 and 1 respectively. The NF was found to be located lateral to, medial to and on the soleal line in 84, 0 and 2 cases in right tibia, and 82, 1 and 3 cases in left tibia. Distance of NF from junction of upper 1/3 & middle 1/3 of shaft was found to be (in Mean + SD) 17.8+3.1 and 17.6+2.9 for right and left tibia.
The present work should provide various disciplines of doctors, especially orthopedic surgeons with data that will help in various surgical procedures, especially to avoid damage to the nutrient vessels. Still, further research work with other parameters should be carried out.