BACKGROUND: Proximal Femoral Focal Deficiency (PFFD) is the most proximal manifestation of a syndrome involving Congenitally Shortened lower Limbs (CSL), which also affects the fibula and midline metatarsals. This pattern of congenital human long bone deficiencies corresponds, in a time dependent manner, to the failed ingrowth pathways of new blood vessels of the growing embryonic limb. The distal femoral condyles are, in contrast, served by an alternative vascular supply from around the knee joint, and so remain resistant to the CSL deficiency. AIM: We hypothesize that embryonic vascular dysgenesis causes PFFD, as well as the cardinal features of the Femoral, Fibular and midline Metatarsal deficiencies (FFM) syndrome. RESULTS: Arteriography of CSL with PFFD reveals diminution or failed formation of the Femoral Artery (FA), which corresponds to downstream skeletal reductions. It may also reveal preservation of the primitive Axial Artery (AA) of the embryonic limb. The combination of missing and retained primitive vessels inform the time, place, and nature of the etiologic vascular events. This suggests that PFFD is the visible expression of a normally prefigured cartilaginous scaffold of the femur, which develops in conformity with the available pattern of blood vessels present. The teratogen thalidomide, known to affect the forming embryonic vasculature, also produces PFFD indistinguishable from the naturally occurring entity. CONCLUSION: The entire spectrum of PFFD, including phocomelia, fibular, and metatarsal dystrophisms, should thus be regarded as downstream skeletal results of embryonic arterial dysgeneses.

• Klíčová slova
• congenitally shortened lower limbs (CSL), dystrophisms, femoral, fibular, and midline metatarsal deficiencies (FFM), limb differences, phocomelia, proximal femoral focal deficiency (PFFD), thalidomide, vascular patterning,
• MeSH
• arteria femoralis * abnormality   embryologie   MeSH
• femur * abnormality   krevní zásobení   embryologie   MeSH
• fibula abnormality   krevní zásobení   MeSH
• lidé MeSH
• metatarzální kosti abnormality   MeSH
• vrozené deformity dolní končetiny * embryologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF STUDY: Inadequate treatment of displaced fractures of the navicular bone may result in malalignment, formation of non-union, accelerated development of osteoarthritis or avascular necrosis and thus a fundamental limitation of mobility and gait disturbance. The aim of our study was to evaluate the results in our group of patients undergoing surgery for navicular fractures. MATERIAL AND METHOD: Our retrospective monocentric study included all surgically treated navicular fractures in patients over 18 years of age performed in our department between 2009 and 2018. A total of 18 patients met these criteria and were invited for clinical and radiographic follow-up. One patient refused to attend and two were lost to follow-up. The remaining 15 patients underwent clinical assessment, including the use of AOFAS midfoot and VAS scores, and the grade of osteoarthritis was determined using radiographs. RESULTS: Our final group of patients consisted of six women and nine men. The mean age of the patients at the time of surgery was 43 (21-67) years, with mean follow-up duration of 68 (18-130) months. The most common mechanism of trauma was high-energy injury occurring in nine of cases. According to the Schmid classification, six fractures were Type I and II each whereas three cases were Type III fractures. Concomitant injuries involving the foot and ankle were present in six cases. All fractures healed.Open reduction and internal fixation (ORIF) was performed in 14 cases. The radiographs showed the presence of osteoarthritis grade 0 or I in nine patients and osteoarthritis grades II and III in six patients. The AOFAS Midfoot scale was excellent and good in eleven cases, satisfactory in two and poor also in two cases. The average AOFAS Midfoot scale was 87.7 points. A procedure-related complication was a case of skin necrosis in a patient eventually undergoing cuneonaviculotalar arthrodesis in another hospital. DISCUSSION: Consistent with literature data, our group showed a higher incidence of concomitant injuries in the foot region. Use of two approaches was not associated with an increased risk of developing avascular necrosis. We do not recommend the use of Kirschner wires for definitive osteosynthesis although we do use them as part of staged treatment or as an additional type of fixation. Like other authors, we observed higher grades of post-traumatic osteoarthritis in the subgroup of patients with more severe injuries. CONCLUSION: Open reduction and stable osteosynthesis of navicular fracture-displacements are associated with good outcomes in most patients. The most serious consequences of these fractures are post-traumatic arthritis and pain. It is critical to search for concomitant injuries. Given the rarity of these fractures, they should be preferably treated in specialised medical centres.

• Klíčová slova
• foot, fracture, hindfoot., tarsal navicular,
• MeSH
• dospělí MeSH
• fraktury kostí * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• osteoartróza chirurgie   etiologie   MeSH
• radiografie metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tarzální kosti * zranění   chirurgie   MeSH
• vnitřní fixace fraktury * metody   škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Avascular necrosis (AVN) of the talus in a posttraumatic setting describes a condition of temporary or permanent bone death of a different extent, initiated by a circulatory disturbance. It is estimated that about 75% of all talar AVNs are caused by a prior trauma. The incidence of posttraumatic AVN rises with higher energy of injury, severity of talar body or neck displacement, fracture comminution, and injury to the soft tissues and major vessels in the lower leg and ankle region. These conditions are often seen in open fractures, fracture dislocations, and pure dislocations.

• Klíčová slova
• Fracture, Fusion, Malunion, Necrosis, Nonunion, Replacement, Talus, Vascularized bone graft,
• MeSH
• fraktury kostí komplikace   MeSH
• lidé MeSH
• osteonekróza * etiologie   terapie   prevence a kontrola   MeSH
• talus * zranění   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The pertinent literature widely describes ultrasound-guided procedures targeting the retrocalcaneal bursa and the tendon tissue to manage insertional Achilles tendinopathy. Synovial bursae and cutaneous nerves of the superficial retrocalcaneal pad are often overlooked pain generators and are poorly considered by clinicians and surgeons. A layer-by-layer dissection of the superficial soft tissues in the retrocalcaneal region of two fresh frozen cadavers was matched with historical anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob). An accurate and detailed description of the superficial retrocalcaneal pad with its synovial bursae and cutaneous nerves was provided. Cadaveric dissections confirmed the compartmentalized architecture of the superficial retrocalcaneal fat pad and its histological continuum with the superficial lamina of the crural fascia. Superficial synovial tissue islands have been demonstrated on the posterior aspect of the Achilles tendon in one cadaver and on the posterolateral surface of the tendon in the other one. Digitalization of the original anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob) showed five potential locations of the superficial calcaneal bursa and a superficial retrocalcaneal nerve plexus within the Achilles tendon-fat pad interface. In clinical practice, in addition to the previously described interventions regarding the retrocalcaneal bursa and the tendon tissue, ultrasound-guided procedures targeting the synovial and neural tissues of the superficial retrocalcaneal pad should be considered to optimize the management of insertional Achilles tendinopathy.

• Klíčová slova
• Achilles tendon, injection, medial calcaneal nerve, sonography, sural nerve, synovial bursa,
• MeSH
• Achillova šlacha * anatomie a histologie   diagnostické zobrazování   MeSH
• bursa synovialis * anatomie a histologie   diagnostické zobrazování   MeSH
• intervenční ultrasonografie metody   MeSH
• lidé MeSH
• mrtvola * MeSH
• patní kost * anatomie a histologie   inervace   diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Os vesalianum pedis (OVP) is a rare accessory bone of the foot located at the base of the fifth metatarsal bone. It is usually asymptomatic and incidentally seen on radiographs. When symptomatic, it manifests itself with lateral foot pain. OVP, which can become symptomatic as a result of traumatic injuries, can also be confused with fracture. The aim of this study is to determine the prevalence and morphometric characteristics of OVP in the Turkish population. MATERIAL AND METHODS: Radiographic images of 5268 individuals aged 16 years and older (mean 39.65±17.21) who completed ossification of the fifth metatarsal bone were evaluated for OVP. Of the cases included in the study, 44.8% were female and 55.2% were male. The general and sex-based prevalence of OVP was calculated, and morphometric measurements were done. RESULTS: OVP prevalence in the Turkish population was found to be 0.15% regardless of sex. OVP prevalence was calculated to be 0.24% in men and 0.04% in women. CONCLUSIONS: Anatomy, radiology, orthopedics and emergency medicine physicians are frequently encountered with foot disorders in clinical and educational practices. It is important to keep in mind the rare presence of OVP (0.15%), in the preliminary diagnosis. KEY WORDS: os vesalianum pedis, accessory ossicle, foot, radiography.

• MeSH
• dospělí MeSH
• klinická relevance MeSH
• lidé středního věku MeSH
• lidé MeSH
• metatarzální kosti * diagnostické zobrazování   abnormality   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prevalence MeSH
• radiografie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Turecko epidemiologie   MeSH

Insertional Achilles tendinopathy is an umbrella medical term referring to pain and swelling on the posterior aspect of the calcaneus. High-resolution ultrasound imaging is commonly used in daily practice to assess the pathological changes of the Achilles tendon, cortical bone of the calcaneus, and soft tissues located inside the retrocalcaneal space to optimize the management of relevant patients. To the best of our knowledge, a standardized ultrasound protocol to evaluate the retrocalcaneal bursal complex is lacking in the pertinent literature. In this sense, our step-by-step sonographic approach is intended to be an easy and ready-to-use guide for sonographers/physicians in daily practice to assess this anatomical complex in patients with Achilles tendinopathy. Needless to say, the peculiar histological features of this V-shaped synovial/fibrocartilaginous bursa surrounding the posteroinferior wedge of the Kager's fat pad and the retrocalcaneal space make the examination challenging.

• Klíčová slova
• Achilles tendinopathy, enthesis, heel pain, retrocalcaneal bursa, ultrasonography,
• MeSH
• Achillova šlacha * diagnostické zobrazování   MeSH
• bursa synovialis * diagnostické zobrazování   MeSH
• lidé MeSH
• patní kost * diagnostické zobrazování   MeSH
• tendinopatie * diagnostické zobrazování   MeSH
• ultrasonografie metody   normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH

PURPOSE OF THE STUDY: In our study, it was aimed to evaluate the efficacy of microfracture and retrograde subchondral drilling on clinical outcomes in patients who underwent ankle arthroscopy due to osteochondral lesion of medial talus. MATERIAL AND METHODS: Twenty eight patients with osteochondral lesion of talus less than 1.5 cm2 treated with ankle arthroscopy were evaluated retrospectively. Microfracture was performed in 16 patients and retrograde subchondral drilling was performed in 12 patients that there was no loss of integrity in the cartilage layer or cartilage layer is partially preserved during ankle arthroscopy. Postoperative evaluations of the patients were done with Foot and Ankle Ability Measure (FAAM) and results of both group were compared statistically. RESULTS: The mean activities of daily living scale was 93.4±3.2 and sportive activity scale was 90.1±5.7 in the retrograde drilling group. In the micro-fracture group, mean activities of daily living scale was 93.8±4.1 and mean sportive activity scale was 88.9±9.5. No significant difference was found as a result of statistical comparisons of both groups results. DISCUSSION: It has been determined that the size and preservation of the integrity of talar osteochondral lesions are important factors on clinical results. Results of arthroscopic debridement, microfracture and drilization are not good in lesions larger than 1.5 cm2 and lesions with impaired integrity. In our study, depending on the general literature, osteochondral lesions in talus were less than 1.5 cm2 in patients who underwent arthroscopic micro fracture and retrograde drilling. CONCLUSIONS: Both microfracture and retrograde subchondral drilling are effective treatment methods with good clinical results for talar osteochondral lesions less than 1,5cm2 . Retrograde subchondral drilling can be an alternative treatment method with the reliability of clinical results in patients with no loss of the integrity of the cartilage layer or cartilage layer is partially preserved. KEY WORDS: talus, osteochondral lesion, microfracture, subchondral drilling.

• MeSH
• artroplastika subchondrální metody   MeSH
• artroskopie * metody   MeSH
• činnosti denního života MeSH
• dospělí MeSH
• hlezenní kloub chirurgie   MeSH
• kloubní chrupavka * chirurgie   zranění   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• talus * chirurgie   zranění   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Glucocorticoids are commonly used in children with different chronic diseases. Growth failure represents a so far untreatable undesired side-effect. As lithium chloride (LiCl) is known to induce cell renewal in various tissues, we hypothesized that LiCl may prevent glucocorticoid-induced growth failure. METHODS: We monitored growth of fetal rat metatarsals cultured ex-vivo with dexamethasone and/or LiCl, while molecular mechanisms were explored through RNA sequencing by implementing the differential gene expression and gene set analysis. Quantification of β-catenin in human growth plate cartilage cultured with dexamethasone and/or LiCl was added for verification. RESULTS: After 14 days of culture, the length of dexamethasone-treated fetal rat metatarsals increased by 1.4 ± 0.2 mm compared to 2.4 ± 0.3 mm in control bones (p < 0.001). The combination of LiCl and dexamethasone led to bone length increase of 1.9 ± 0.3 mm (p < 0.001 vs. dexamethasone alone). By adding lithium, genes for cell cycle and Wnt/β-catenin, Hedgehog and Notch signaling, were upregulated compared to dexamethasone alone group. CONCLUSIONS: LiCl has the potential to partially rescue from dexamethasone-induced bone growth impairment in an ex vivo model. Transcriptomics identified cell renewal and proliferation as candidates for the underlying mechanisms. Our observations may open up the development of a new treatment strategy for bone growth disorders. IMPACT: LiCl is capable to prevent glucocorticoid-induced growth failure in rat metatarsals in vitro. The accompanying drug-induced transcriptomic changes suggested cell renewal and proliferation as candidate underlying mechanisms. Wnt/beta-catenin pathway could be one of those novel mechanisms.

• MeSH
• beta-katenin * metabolismus   MeSH
• chlorid lithný * farmakologie   MeSH
• dexamethason * farmakologie   MeSH
• glukokortikoidy farmakologie   MeSH
• krysa rodu Rattus MeSH
• lidé MeSH
• metatarzální kosti * účinky léků   MeSH
• potkani Sprague-Dawley MeSH
• proliferace buněk účinky léků   MeSH
• růstová ploténka účinky léků   metabolismus   MeSH
• signální dráha Wnt účinky léků   MeSH
• vývoj kostí účinky léků   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• beta-katenin * MeSH
• chlorid lithný * MeSH
• dexamethason * MeSH
• glukokortikoidy MeSH

The neuropathic compression of the tibial nerve and/or its branches on the medial side of the ankle is called tarsal tunnel syndrome (TTS). Patients with TTS presents pain, paresthesia, hypoesthesia, hyperesthesia, muscle cramps or numbness which affects the sole of the foot, the heel, or both. The clinical diagnosis is challenging because of the fairly non-specific and several symptomatology. We demonstrate a case of TTS caused by medial dislocation of the talar bone on the calcaneus bone impacting the tibial nerve diagnosed only by ultrasound with the patient in the standing position.

• Klíčová slova
• Diagnosis, Nerve compression syndromes, Tarsal tunnel syndrome, Tibial nerve, Ultrasonography,
• MeSH
• dislokace kloubu diagnostické zobrazování   diagnóza   etiologie   MeSH
• lidé MeSH
• syndrom tarzálního tunelu * etiologie   diagnóza   diagnostické zobrazování   MeSH
• talus * diagnostické zobrazování   abnormality   MeSH
• ultrasonografie * metody   MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: This manuscript aims to present the method of arthroscopic assisted subtalar arthrodesis and to evaluate the benefi ts of this surgery on our study population. MATERIAL AND METHODS: In the period from 9/2007 to 1/2020, a total of 33 subtalar arthrodesis were performed in 31 patients aged 19-66 years (mean 48 years, median 50 years). The indication for arthrodesis was subtalar arthritis causing pain and gait disorders, or hindfoot deformities (most commonly after a calcaneus bone fracture). The arthroscopic assisted subtalar arthrodesis was performed with autologous tricortical bone block graft harvesting from the pelvis, supplemented by autologous cancellous bone graft. Stabilization was achieved by cannulated screws inserted in neutral ankle position. Patients in our retrospective study were followed up for a mean of 48 months (range, 24-130 months). The patients were evaluated preoperatively and at 2 years after surgery. The hindfoot angles and height (TCA - talocalcaneal angle, CIA - calcaneal inclination angle, TCH - talocalcaneal height) were evaluated on radiographs, bone union was assessed on radiographs and CT scans. The clinical assessment was performed using the ankle-hindfoot scale (AHS) of AOFAS (AOFAS score). RESULTS: The preoperative AOFAS score was 35-68 points (mean 52, median 54), the postoperative AOFAS score at 2 years after arthrodesis was 58-94 points (mean 82, median 82). Both the mean and median values of AOFAS score showed a signifi - cant progress from the poor result to the good and excellent result. After 2 years the TCA value decreased in 18 patients (56%) by no more than 3°. The CIA decrease observed in 21 patients (64%) was by 1° on average. The TCH decrease of 1-5 mm after 2 years since the surgery was seen in 16 patients. In 2 patients incomplete healing of arthrodesis was observed, manifested as a clinically asymptomatic non-union. No deep infection was reported. DISCUSSION: In agreement with the current literature, the arthroscopic subtalar arthrodesis has been confi rmed to be a safe method for the management of consequences of hindfoot fractures, with minimum complications and leading to accelerated bone fusion. Differences can be found in the approach, position, use of cancellous bone graft and surgical techniques. In recent years, prone position, posterior approaches, use of cancellous bone graft, distraction and fi xation with 2-3 screws divergently inserted into the bone prevail. The degree of healing of the bone fusion is generally an important factor. In our study population, non-healing was recorded in 2 patients, namely in the form of a clinically silent non-union. Neurological or early complications and/or osteosynthesis material failure occurred in up to a maximum of 10% of cases. The conclusive results of minimally invasive arthrodesis based on the AOFAS score have been confi rmed by us as well as by most authors. CONCLUSSIONS: Our study confi rmed that the arthroscopic assisted subtalar arthrodesis is a successful, reliable and safe minimally invasive method, with minimum complications, leading to stable arthrodesis. KEY WORDS: subtalar arthrodesis, subtalar arthroscopy.

• MeSH
• artrodéza MeSH
• dolní končetina MeSH
• fraktury kostí * MeSH
• lidé MeSH
• noha (od hlezna dolů) MeSH
• patní kost * chirurgie   MeSH
• poranění kotníku * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH