Ankle injuries are a frequent cause of patient visits to the emergency department and orthopaedic and primary care offices. Although lateral ligament sprains are the most common pathologic conditions, peroneal tendon subluxations occur with a similar inversion mechanism. Multiple grades of subluxation have been described with a recent addition of intrasheath subluxation. Magnetic resonance imaging is the best imaging modality to view the peroneal tendons at the retrofibular groove. Currently, point-of-care ultrasound is gaining clinical ground, especially for the dynamic viewing capability to capture an episodic subluxation. Although conservative treatment may be attempted for an acute injury, it has a low rate of success for the prevention of recurrent subluxation. Surgical procedures of various techniques have resulted in excellent recovery rates and faster return to play. The aim of this paper was to give a complete review of the current literature on peroneal tendon subluxation and to propose a clinical algorithm to help guide diagnosis and treatment. The goal of this study was to heighten clinical awareness to improve earlier detection and treatment of this sometimes elusive diagnosis.
A radiographic and histologic study of bat bones showed that there is a progressive loss of bone tissue during hibernation and abrupt reversal at arousal. Enhanced osteolysis accounted for the bone loss; osteoclasia was not observed.Increasing evidence strongly indicates that the parafollicular cells (light cells, C cells) of the thyroid gland synthesize calcitonin, the bone resorption inhibiting hormone (Pearse, '66; Matsuzawa and Kurosumi, '67; Ericson, '68). Although the importance of calcitonin in mammalian physiology is still enigmatic (Hirsch and Munson, '69), strong evidence that calcitonin may be physiologically important in the hibernator has been found. Parafollicular cells are sparse in the thyroid glands of most mammals (Stux, Thompson, Isler and Leblond, '63; Young, Duncan and Care, '68; Klinck, Oertel and Winship, '70), but they are widespread and abundant in the thyroid glands of hibernators (Azzali, '66; Azzali, '67; Nunez, Gould, Hamilton, Hayward and Holt, '67; Pearse and Welsch, '68; Gabe and Martoja, '69; Olivereau, '70).In the bat, parafollicular cells show rather striking seasonal variations in fine structure. During the first half of hibernation, the amount of granular endoplasmic reticulum is greatly reduced and the calcitonin-secretion granules lose their solid dense core (Nunez et al., '67; Nunez, Gould and Holt, '70) suggesting that calcitonin may be functionally inactive during the hibernation period. Cessation of calcitonin secretion during hibernation should result in increased bone resorption. However, the few reports on bone changes in hibernation are incomplete and conflict (Mayer and Bernick, '63; Bruce and Wiebers, '69). Therefore, in an effort to determine the effects of hibernation on ANAT. REC., 172: 97-108.bone and the mechanisms involved, and to establish possible interrelationships between bone changes and parafollicular cell activity, a histologic and radiographic study of the femur of active, prehibernating and hibernating bats was carried out. The results of the study are reported herein. MATERIAL AND METHODSThe bats used in this study were adult 'Myotis lucifugus, were of either sex, and were obtained from caves in Central Illinois before (September), during (November, December, January, and February) and after hibernation (late April) and are illustrated in figure 1. Bones were dissected and cleaned of soft tissues and pIaced in 10% fonnalin until they were radiographed and processed for histological examination.The bones were radiographed in a Faxitron 804 self-contained unit having a tungsten target and a 40 mil. Beryllium window. The nominal focal spot size was 0.5 mm. The tube was operated at 10 K.V.P., 3 MA, for exposure times of three minutes at a 24" focus-film distance. Kodak RPM film (having a speed value, grain size and contrast characteristics between industrial type M and industrial type A film) was used and processed through a medical X-Omat using a 90 second cycle. The radiographs were examined by light microscopy and were photographed a...
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