Joined: November 15, 2003
Jeep, I can't remember exactly where I read it, as I have been reading a lot lately, and I think it was Skoyles and Sagan's Up From Dragons... but it has been recorded that something like 20% of people have no palmaris longus at all, and a much smaller percentage have two adjacent PLs, not necessarily on both sides. L6 is an extra Lx vertebra, present in a fairly low percentage (sorry, can't recall the figure) of people, which may or may not sacralise.
Is that what you mean? Perhaps the genes get a bit fuzzy for some and an extra thing is added or taken away.
Joined: September 15, 2004
There appears to be some edema on the first film superior to the lateral chondyle and the quad tendon attachment seems a bit odd at the patella with some soft tissue changes. I am not sure what the technical jargon is though.
Joined: March 1, 2004
The proximal fibula is laterally dislocated. No evidence of fracture.
I posted a radiograph below showing the normal relationship of tibia to fibula in the AP view. There should be some overlap of the fibula and tibia as seen below. The lateral view is also helpful but we were unable to get a true lateral view.
The patient was tender to palpation over the fibular head and there was soft tissue swelling only laterally. He had pain over the lateral knee with passive extension. The dislocated fibula was easy to palpate. A physician assistant and I tried to relocate the fibula using local anesthetic but we were unable to budge it. He was sent to an ortho surgeon who was able to relocate it in the OR. This is the first one of these that I have ever seen.
Which structure over the lateral knee would you be most concerned about when trying to relocate the fibula?
Good job to SJBird and to Randy Dixon's wife.
< Message edited by David Adamczyk -- July 13, 2007 3:08:24 AM >
Joined: March 1, 2004
You are correct. The fibular nerve (new anatomical name for it) would be the structure that you would be most concerned about.
Here is a pretty good article that relates well with this case study. "Instability of the Proximal tibiofibular joint". Sekiya JK, Kuhn JE. Journal of the American Academy of Orthopaedic Surgeons. Vol 11, No 2, March/April 2003.
they quote, "Plain film radiographs should be taken of the knee in true anteroposterior and lateral views. Comparison radiographs of the contralateral knee can substantially improve the ability to diagnose instability of the proximal tibiofibular joint. On the lateral view, the fibular head overlies the posterior border of the tibia. Resnick et al described a line on lateral radiographs that follows the lateral tibial spine distally along the posterior aspect of the tibia and defines most posteromedial portion of the lateral tibial condyle. In a normal knee, this line is found over the midpoint of the fibular head. In anterolateral dislocations, the fibular head will be anterior to this line on the lateral view. In posteromedial dislocations, all or most of the fibular head is posterior to this line on the lateral view." See below.
Above: Lateral radiograph of a normal knee indicating Resnick's line (yellow) for identifying instability of the proximal tibiofibular joint. In this knee, the line is near the midpoint of the fibular head.
Joined: August 25, 2000
Thanks for the reference and the highlight on the radiographs. Makes it easier to see. Was not aware of this. This was not even mentioned in the radiology class I took not too long ago. Nice to know about it now. Keep them coming!