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Avascular necrosis (AVN) after bunion surgery is an unfortunate complication which can be devastating and painful. We present a case report of gradual medializing transport of the second metatarsal with external fixation to repair a large bone defect caused by AVN affecting >50% of the first metatarsal. The procedure was performed on a 49-year-old female who suffered AVN after failed bunion surgery. At 12-month follow up, first ray position and length were maintained. With respect to the second ray, there were no clinically significant issues. The second digit was mildly elevated but there was no frank instability of the toe or of the Lisfranc complex. The patient was pain free and had returned to her desired daily activities.

We report the case of a 14-year-old girl who experienced a Lisfranc fracture-dislocation while playing sport. The lesion was treated with surgery, consisting of open reduction and internal fixation using cannulated screws and Kirschner wires. After one year of follow-up, the patient has no symptoms and no X-ray evidence of degenerative changes in the midfoot. In our view, the surgical procedure, using rigid fixation for the medial column and the second ray, and a provisional fixation to all other rays, allowed for a satisfactory short-term result in this patient. We have used this case to review the management of this lesion in the pediatric population. [Arch Clin Exp Surg 2019; 8(2.000): 53-57]

ResumoA periostite reativa florida é uma lesão benigna e rara que constitui um problema recorrente de diagnóstico. Sua etiopatogênese permanece desconhecida. A periostite reativa florida caracteriza-se por ser uma reação periosteal agressiva e inflamatória de tecido mole e por ser um tumor portador de fibrose e produtor de cartilagem. Ocorre em adolescentes e adultos jovens, com predomínio no sexo feminino, e acomete com frequência os ossos das mãos e pés, podendo acometer também ossos longos. O diagnóstico permanece um grande desafio devido à enorme possibilidade de diagnósticos diferenciais. Por isso, uma cuidadosa avaliação clínica, radiológica e patológica é necessária para fechar o diagnóstico. Relata-se o caso de um paciente com periostite reativa florida na falange proximal do segundo dedo da mão direita, que foi submetida à excisão cirúrgica com margem ampla do segundo raio até o terço proximal do segundo metacarpo, e evoluiu sem queixas, com amplitude de movimento e força satisfatória.

Background: We hypothesized that the cause of second-ray pathology with hallux valgus is excessive relative length of the second metatarsal and performed Weil osteotomy to shorten it, with correction of hallux valgus. The purpose of this study is to evaluate the outcome of second-ray pathology after distal chevron osteotomy (DCO) with Weil osteotomy to correct metatarsal parabola. Methods: We performed concomitant Weil osteotomy of the second metatarsal with DCO of the first metatarsal as part of hallux valgus with second-ray pathology correction surgery in 45 feet (40 patients). Second-ray pathologies were claw toe deformity, painful plantar callosity, second metatarsophalangeal joint (MTPJ) dislocation, and osteoarthritis (OA) of the second MTPJ. We measured projection of the second metatarsal (PSM), metatarsal protrusion index (MPI), and metatarsal protrusion distance (MPD). The second-ray surgery outcome was assessed by patient satisfaction. Results: Patient satisfaction was good in claw toe deformity and OA (satisfaction rate: 60% [23 patients] and 71% [7 patients], respectively) and fair in painful plantar callosity and second MTP joint dislocation (satisfaction rate: 44% [9 patients] and 33% [6 patients], respectively). Total patient satisfaction rate was higher when the PSM, MPI, and MPD ranged between 7 and 12 mm, −5 and 0 mm, and 0 and 4 mm, respectively. Conclusions: We concluded that simultaneous performance of hallux valgus correction and Weil osteotomy in patients with second-ray pathologies associated with hallux valgus was safe as well as effective. Correcting the metatarsal parabola within the appropriate range after surgery is associated with second-ray pathology outcome.Levels of Evidence: Therapeutic studies, Level VI: Case series

Purpose This study compares the amount of joint preparation and first ray shortening following first metatarsophalangeal (MTP) joint fusion utilizing open conical reaming versus arthroscopic technique. Methods Ten below-knee cadaver specimens were randomly assigned to undergo either open or arthroscopic first MTP fusion. Following fixation, first ray length measurements were obtained from pre-operative and post-operative radiographs and were used to determine first ray shortening. Additionally, the ratio of first ray length to second ray length was calculated both pre-operatively and post-operatively and compared between the two approaches. All ankles were then completely dissected, and prepared surface areas were demarcated. ImageJ photo analysis software (National Institutes of Health, Bethesda, MD, USA) was used to calculate the percentage of prepared and unprepared cartilage of each articular surface of each specimen. Results Overall, the open approach resulted in 99.3% ± 1.6% joint surface preparation, whereas the arthroscopic approach yielded 92.9% ± 7.2% (p = 0.089). On average, the head of the first metatarsal was significantly more prepared with the use of the open approach (99.5% ± 1.1%) than with the arthroscopic approach (96.6% ± 1.5%) (p = 0.008). However, with respect to the base of the phalanx, the average difference in preparation between the arthroscopic approach and the open approach was not statistically significant (90.0% ± 12.8% vs. 99.0% ± 2.2%; p = 0.160). The average amount of first ray shortening in the arthroscopic approach was 2.2 ± 1.8 mm compared to 2.1 ± 3.2 mm in the open approach (p = 0.934). The average change in the first to second ray length ratio was 0.02 for both approaches (p = 0.891). Conclusion Arthroscopic first MTP fusion can be used to achieve joint preparation comparable to open technique while maintaining first ray length.

A new deepwater species, Enneapterygius velatus sp. nov. (Perciformes: Tripterygiidae), is described from two male specimens from Ryukyu Island, southern Japan, the holotype having been collected at a depth of 55 m and an underwater photograph taken between 30 and 41 m depth. The new species is characterized by an extremely long first dorsal-fin spine (length 31.6–34.0 % of SL), the first dorsal-fin spine bases close together, first dorsal-fin base length less than half the distance between the base of the third spine of the first dorsal-fin and origin of second dorsal-fin, first dorsal-fin spine base with developed inclinator muscles, long pelvic fins (tip of second ray extending beyond anal-fin origin), large body scales (8 circumpeduncular scales), the supratemporal sensory canals deeply U-shaped in dorsal view, snout profile weakly rounded, abdomen from between pelvic-fin bases to anal-fin origin covered by cycloid scales, body lacking significant blackish blotches and caudal-fin base with scattered melanophores in preserved specimens.

Aim Evaluation of clinical and functional outcome of ray resection in paediatric population and description of key aspects of surgical technique. Material and methods We performed a retrospective review of all patients undergoing surgery between 2010 and 2015. Inclusion criteria: one or more ray resections of the hand and a minimum of one year follow-up. Evaluation of clinical characteristics, functional and cosmetic results, complications, need for psychological support and patient or family satisfaction. Results Four patients met the inclusion criteria. The mean age at surgery was 5 years (range, 1–14 years). Aetiology was: fibrolipomatous hamartoma, traumatic amputation, radial deficiency and complex syndactyly. Second ray was resected in three patients and third and fourth ray in one. No finger transfer was performed. No immediate post-operative complications were found at the final evaluation. None of them needed psychological support. All the patients showed excellent clinical and functional results with a high grade of satisfaction. Discussion Ray resection of the hand has been used as salvage procedure in patients with vascular lesions, tumours, trauma, infections or congenital malformations. There are only a few published studies including small samples in adults or case reports, with no references in the paediatric population. Conclusion Ray resection of the hand is a useful and safe technique in paediatric population, obtaining excellent cosmetic and functional results in those cases in which it is impossible to preserve one or more fingers.

Amputation of the second ray is a surgical treatment option when reconstruction and/or reimplantation fail. The aim of our study was to review the outcomes after transmetacarpal resection of the second ray following a post-traumatic injury and to assess indications, functional outcomes, and patient satisfaction. Between January 2003 and December 2013, 25 patients (6 women and 19 men with a mean age of 51 years) underwent transmetacarpal resection of their second ray after a post-traumatic injury. Sixteen patients were right-handed and 9 were left-handed. Injuries involved the dominant hand in 14 cases (60%). In order to differentiate patients with preserved index finger length preoperatively from those with a shorter, amputated index finger stump, patients were divided into 2 groups. Group 1 included those with an "intact finger" and Group 2 included patients with an "amputated stump". Data collection, including patient satisfaction and functional outcomes, was performed at 83 months postoperative on average. Average length of follow-up was 7.0±1.0 years (range 5-12 years). Group 1 (intact finger) and 2 (amputated stump) included 15 and 10 patients, respectively. Six patients (24%) had primary ray amputation and 19 (76%) had secondary ray amputation. No surgical revision was necessary. In Group 1, the indications were purely functional in all but two cases, whereas aesthetic indications played a role in all patients in Group 2. The average total time off work was 3 months. There was no difference between Group 1 and 2 (P>0.05). However, patients with primary ray resection averaged 10 weeks of lost work compared to 17 weeks for secondary amputation. There was no functional difference between Groups 1 and 2. Scores for cosmetic appearance and patient satisfaction were higher in Group 2. In certain specific situations after complex hand trauma, transmetacarpal amputation of the second ray is indicated as soon as possible, in order to reduce the time off work. Patient satisfaction following this surgical procedure is high, especially in groups with amputated stumps. A 30% decrease in pinch and grip strength is the rule. No secondary surgery is normally required.

The sagittal plane relationship of the first to second ray is a primary determinant of proper alignment in Lapidus midfoot fusion as assessed both clinically and on postoperative weightbearing lateral radiographs. The traditional approach to intraoperative fluoroscopic imaging allows for accurate assessment of fixation placement and intermetatarsal angle correction but only a crude evaluation of final sagittal plane alignment. Surgeons have used various methods in an attempt to load the foot during lateral imaging. This had led to inconsistent results and the potential for poor outcome. Skepticism exists regarding the ability of simulated weightbearing fluoroscopy to predict the final outcome, and evidence is lacking to support this practice. A prospective investigation was performed to assess the correlation of the first to second ray sagittal plane alignment as demonstrated on intraoperative simulated weightbearing lateral foot imaging studies and the 10-week postoperative lateral weightbearing radiograph. A consistent simulated weightbearing technique was used prospectively with 50 consecutive cases of Lapidus midfoot fusion with the goal of achieving parallel sagittal plane alignment of the first and second metatarsals with no divergence. Although 47 cases had no divergence and 3 had divergence with mild first ray elevatus, all 50 cases demonstrated a direct correlation between the intraoperative simulated and postoperative full weightbearing images. In conclusion, we believe the findings from our intraoperative imaging technique are a reliable predictor of first ray sagittal plane alignment in Lapidus midfoot fusion.

Background: Hallux valgus can alter load bearing in the foot leading to abnormal forces on the second toe. The purpose of this study was to determine demographic and radiographic factors associated with second ray hammertoes in hallux valgus using 3-dimensional weightbearing CT scans. Methods: Seventy-one patients who underwent a modified Lapidus procedure for hallux valgus with preoperative weightbearing CT scans were separated into 2 groups: (1) hallux valgus only (47 feet) and (2) hallux valgus with second ray hammertoe (29 feet). Preoperative age, body mass index (BMI), sex, hallux valgus angle (HVA), intermetatarsal angle (IMA), absolute and effective metatarsal (MT) lengths, ratios between metatarsal lengths, Meary angle, metatarsus adductus angle (MAA), and pronation were measured. Mean values of continuous variables were compared and both simple and multivariable logistic regression models were used to evaluate associations between variables and hammertoe occurrence. Results: Patients in the hammertoe group were found to be significantly older and have higher BMIs, HVAs, effective second MT lengths, IMAs, and more apex plantar Meary angles (all P < .05). The multivariable analysis demonstrated that a higher IMA and a more apex plantar Meary angle were the only significant predictors of second ray hammertoe risk ( P = .03 and P = .01, respectively) once corrected for age and BMI. Conclusion: Significant associations were found between older age, higher BMI, and more severe deformity and the occurrence of hammertoe in hallux valgus patients. These results may help clinicians counsel hallux valgus patients about the risk of developing an advanced hammertoe deformity. Level of Evidence: Level III, retrospective comparative series

Background: Metatarsophalangeal joint (MPJ) instability, which often involves the second ray, may result in dorsal translation and coronal drift of the proximal phalanx, with subsequent crossover of the first and second toe. After traditionally described soft tissue and osteotomy procedures are used to treat this deformity, coronal plane malalignment may persist, but few additional surgical options have been described to address this problem. Methods: We present a retrospective series of 5 patients who underwent a supplemental technique to augment coronal plane MPJ realignment. All patients underwent preplanned concomitant procedures. Crossover angulation of the second MPJ, amount of coronal translation required, and overall first-second ray alignment were compared pre- and postoperatively. Results: Depending on the severity of refractory deformity after soft tissue release and decompressive metatarsal osteotomy, 1.5 to 4.5 mm of coronal plane metatarsal head translation was required to achieve 3 to 20 degrees of overall valgus correction at the MPJ and complete correction of the crossover toe deformity. All patients were satisfied and had good function at last follow-up, a mean of 10.2 months, although 3 patients exhibited some level of second MPJ stiffness. One patient ended up with a component of residual floating toe deformity that was considered more of an incomplete correction of dorsal MPJ subluxation rather than any technical complication of this translational osteotomy modification designed to primarily correct coronal plane malalignment. A second patient had asymptomatic angular malalignment through partial (coronal plane) malrotation of the metatarsal osteotomy before it had healed. Conclusions: We have found this technique modification to be a very effective and simple means of treating recalcitrant lesser MPJ coronal plane malalignment when traditional soft tissue and bony techniques fail to fully restore anatomic MPJ position. Level of Evidence: Level IV, retrospective case series.

Background:Hallux valgus is frequently associated with additional forefoot pathologies, including hammertoes and midfoot osteoarthritis (OA). However, the pathogenesis of these concurrent pathologies remains to be elucidated. We sought to determine whether there is a relationship between demographic and radiographic parameters and the incidence of secondary pathologies in the setting of a bunion, with an emphasis on second tarsometatarsal (TMT) OA and hammertoes.Methods:A total of 153 patients (172 feet) who underwent reconstruction for hallux valgus were divided into 3 groups: (1) bunion only (61 patients), (2) bunion with hammertoe without second TMT joint OA (78 patients), and (3) bunion with second TMT joint OA (14 patients). Preoperative age, sex, and body mass index (BMI) as well as hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), ratio of second to first metatarsal length, and Meary’s angle were recorded. One-way analysis of variance (normality demonstrated) and Kruskal-Wallis (normality not demonstrated) tests were used to assess differences in continuous variables. Post hoc tests were conducted with the Bonferroni technique. Associations between discrete variables and the study groups were analyzed using χ2tests. Following the univariate analysis, multinomial logistic regression models were built to determine potential risk factors for hammertoe or TMT OA group placement.Results:Patients in the hammertoe and TMT OA groups were significantly older than patients in the bunion only group ( P < .001 for both pairwise comparisons) and had significantly higher BMIs ( P = .024 and P < .001, respectively). Patients in the TMT OA group had a significantly higher mean HVA than patients in the bunion-only group ( P = .004) and a significantly higher mean MAA relative to both other study groups ( P ≤ .001 for both comparisons). IMA, Meary’s angle, and the ratio of second to first metatarsal length did not differ significantly between groups. In the multivariate analysis, hammertoe group assignment was predicted only by age and HVA, while midfoot OA group assignment was predicted by age, HVA, BMI, and MAA.Conclusion:Our data show that older age and increased HVA were predictors of both second ray pathologies studied. Higher BMI and MAA were predictive only of TMT joint OA. These data may help identify patients with hallux valgus who are at greater risk for developing secondary pathologies.Level of Evidence:Level III, retrospective comparative series.

Category: Bunion Introduction/Purpose: Hallux valgus deformity is well known to cause second ray pathology, commonly manifested as a second hammertoe or second tarsometatarsal (TMT) joint osteoarthritis (OA). This likely results from decreased weight-bearing capacity of the first metatarsal in the setting of worsening metatarsus primus varus, TMT joint hypermobility, or an excessively long second metatarsal or second toe. It is not known for sure, however, which radiographic and clinical factors in the setting of hallux valgus are protective of second ray pathology and which lead to second hammertoe, TMT joint OA, or both. We hypothesized that the formation of second ray pathology would be correlated with increasing age, increased body mass index (BMI), increased hallux valgus angle (HVA), increased intermetatarsal angle (IMA), and increased second metatarsal length. Methods: All consecutive patients who underwent operative reconstruction for symptomatic hallux valgus from January 2007 to July 2015 by the senior author were included. Patients were grouped into those with 1) bunion only 2) bunion with hammertoe and 3) bunion with second TMT joint OA. Preoperative age, sex, and BMI were recorded. Pre-operative HVA, IMA, metatarsus adductus angle (MAA), and first and second metatarsal lengths were measured on weight-bearing anteroposterior (AP) radiographs. Talar-first metatarsal angle was measured on weight-bearing lateral radiographs. One-way analysis of variance (normality demonstrated) and Kruskal-Wallis (normality not demonstrated) were used to assess differences in continuous variables. Post hoc tests were conducted with Bonferroni technique. Associations between discrete variables and the study groups were analyzed using chi-square tests. Results: Increased age was associated with both hammertoe (P = 0.000) and TMT joint OA (P = 0.006). Increased BMI was associated with TMT joint OA (P = 0.016). Increased HVA was associated with both hammertoe (P = 0.039) and TMT joint OA (P = 0.038). When analyzed categorically, 29.7% of patients with TMT joint OA had a moderate HVA (30.0-39.9 degrees) whereas 22.2% of patients with a bunion only had a moderate HVA (P < 0.05). A one-degree increase in HVA was associated with a 5% chance of having a hammertoe as compared to a bunion only. MAA correlated with TMT joint OA (P = 0.048) (Table 1). Conclusion: Our data suggests that increased age (a surrogate for bunion duration) and increased HVA may predispose patients with hallux valgus to second hammertoe and TMT joint OA formation. Increased BMI may lead to the development of TMT joint OA. Increased MAA may predispose to hammertoe formation. Increased MAA may lead to TMT joint OA. Alternatively, increased MAA could result as a consequence of midfoot cartilage and bone loss in the setting of hallux valgus. This data can help surgeons better inform patients about the optimal timing of bunion reconstruction with or without concomitant second ray surgery.

Second ray syndrome is due to degenerative changes of the plantar plate frequently associated to hallux valgus that may require dedicated surgical correction. An US classification is proposed and its impact on patient management is assessed. A total of 52 patients with hallux valgus and associated metatarsal pain scheduled for surgery were imaged. US resulted in modification of the treatment plan in 32% of patients. The surgical procedure was modified due to a plantar plate lesion not suspected on clinical and routine imaging findings. US improves the surgical management of patients with hallux valgus and second ray syndrome.

Background: We performed an adaptation of the system of evaluation of metatarsal protrusion described by Oller in 1994 to study the metatarsal parabola group. Methods: The system of measurement was applied to the five metatarsals of 169 normal feet (72 feet of women and 97 feet of men) according to the inclusion criteria established. Results: The mean ± SD metatarsal protrusion angle with respect to the second ray in women was 87.49° ± 5.48° for metatarsal I, 70.00° ± 5.74° for metatarsal III, 63.47° ± 4.17° for metatarsal IV, and 56.38° ± 3.27° for metatarsal V. In men, the values were 85.30° ± 6.75° for metatarsal I, 68.00° ± 6.72° for metatarsal III, 60.56° ± 4.61° for metatarsal IV, and 54.13° ± 3.75° for metatarsal V. The comparative analysis between women and men showed significant differences (P < .05) for all of the values of metatarsal protrusion. Conclusions: The comparative analysis between women and men indicates a possible difference between the anthropometric values of these variables in humans, suggesting a possible repercussion on the biomechanical patterns by sex. (J Am Podiatr Med Assoc 99(1): 49–53, 2009)

An effective quantitative method for the evaluation of endocrine-disrupting chemicals based on the secondary sexual characteristics of medaka (Oryzias latipes) using an S-rR strain has been developed in this study. Although the major characteristics of gross morphologies of fish for the detection of the effects of endocrine-disrupting chemicals are GSI (gonadosomatic index) and gonadal morphology, some disadvantages, such as low sensitivity, have been reported. The method we propose here involves the simple counting of the number of nodes in the second ray of the last anal fin. The S-rR strain was exposed to 17β-estradiol (E2) at three concentrations (16, 32 and 64 ng·l-1) from the fertilized-egg stage to the 70-day posthatch. At the termination of exposure, the number of nodes as well as the maximum number of small papillary processes on a ray and the number of rays with small papillary processes in the anal fin were determined. We found that the number of the ray nodes would satisfied with the purpose for quantitatively evaluating effects of endocrine-disrupting chemicals. The present study provides a more convenient and cost-effective method based on the secondary sexual characteristics of medaka that may be used for the reliable evaluation of the effects of endocrine disruptors.*1 The Node Count Method is a new technique for quantitative evaluation of endocrine-disrupting chemicals based on the secondary sexual characteristics of medaka (Oryzias latipes) strain described in this paper. This technique was developed in the research that the National Institute of Advanced Industrial Science and Technology (AIST) entrusted to Sumika Technoservice Corporation.

Progression to severe hallux valgus following the second and third brachymetatarsia is a rare deformity. This condition is a challenging problem because the entire correction of hallux valgus deformity and metatarsal length discrepancy is necessary to prevent a recurrence of deformity. Metatarsal length discrepancy between the first and second ray in early adolescent patient can be aggravated with the course of time and result in a failed hallux valgus correction. Because there are few references in the literature on the operative procedures for this type of combined deformity, we report a case of 11-year-old boy treated with lesser metatarsals lengthening and the first metatarsal corrective osteotomy.

Pollicization of the long finger is rarely performed, and previously described for treating traumatic thumb and index finger loss. Because the long finger lacks the independence of motion and muscular attachments of the index finger, pollicization of the long finger requires modifications of the technique. We present the case of a 3-year-old girl with progressive macrodactyly of the thumb and index finger associated with a lipofibromatous hamartoma of the median nerve. The involved digits were severely enlarged, stiff, and nonfunctional. The child was treated with first and second ray resection followed by long-finger pollicization. Surgical pearls and pitfalls are discussed.

A new clupeomorph fish,Sorbinichthys elusivo n. g., n. sp. is described from a new Upper Cretaceous (Middle ? Cenomanian) marine locality at Nammoura (Lebanon). The characteristic features of the new genus, such as dorsally expanded posttemporal, subrhomboid spiny dorsal scutes, a very wide and deep gap between second and third hypurals, second ray of dorsal and pectoral fins greatly elongated and filamentous, and anterior procurrent caudal fin rays deeply extended between vertebral spines are unusual for clupeomorphs and warrant the establishment of the new family Sorbinichthyidae. The new fish displays several clupeomorph and clupeiform characters, but its placement within the clupeiforms is problematic. The new family is referred to the Clupeomorpha incertae ordinis.

The second ray syndrome, also known as the painful or overloading syndrome of the second ray or of the second metatarso-phalangeal joint, is on the anatomo-pathological plane a more or less complete lesion of the supporting plantar plate of the metatarsophalangeal joint. It consists of a painful instability of the second toe on its metatarsal head, as defined by Denis. This instability leads, after rupture of the plantar plate, to initially reducible and then progressively fixed and irreducible dislocation. The clinical features of the second ray syndrome are pain localised under the second metatarsal head, although the pain may equally involve the whole corresponding joint. There is a progressive development of plantar hyperkeratosis. Clawing of the second toe appears when the phalangeal base starts dislocating. The intrinsic factors leading to this syndrome correspond to an excess length of the second metatarsal. The extrinsic factors leading to it may aggravate the intrinsic causes or may act on their own. Medical treatment is only of value in the initial stage of syndrome. In the later stages surgical treatment involves the metatarso-phalangeal joint, the metatarsal, the toe and the extensor tendon in bony, joint and tendous stages of surgery. The need to involve all of these different sites arises from clinical and radiological assessment. Nevertheless, whatever technique is used, it is essential to shorten the second metatarsal and reduce and stabilise the metatarso-phalangeal joint, predisposing features such as hallux valgus should be treated where necessary.

Analysis of 998 dorsoplantar foot radiographs of 231 patients was performed. Age ranged between 0.21 and 19.94 years. The authors proved the existence of a previously nondescribed additional proximal ossification center in the second metatarsal. This additional proximal center was seen in 78 of 998 radiographs, which corresponds with 7 of the 231 patients. If only 111 patients within the age range in which the additional proximal center appears are considered, the true prevalence of the additional proximal center was found in 7 (6.3%) patients. This additional proximal center was found to be bilateral in 4 (57.1%) of these 7 patients. The presence of the proximal center was more common in girls and was associated with index plus metatarsal type ( P =.000) and foot pathology, especially flatfoot ( P =.000). Age of appearance was 2.3±0.24 years and age of fusion was 5.5±2.2 years. Using a descriptive maturation scale, the authors classified the ossification stages of the additional proximal center in 4 stages: rudimentary, fully formed, partially fused, and fully fused. After creating a mathematical ratio, the authors could not prove that the presence of this additional proximal center increased the length of the second metatarsal or the complete second ray.

A theory of the second ray invariant is proposed using the theory of plane Frenet curves. Its existence requires that the coordinate dependence of the refractive index in the waveguide cross section should satisfy the regularity condition: curves of equal refractive index differ only by an amount which can be obtained using an isotropic scaling transformation. The theoretical conclusions are illustrated using the example of waveguides having the generalized refractive index distribution n ( r ) = n [ (x/ a) + (y/ b)q].

Background: The aims of this study were to determine the severity of metatarsalgia of the second through fifth rays after shortening of the first ray for correction of hallux valgus deformity and patient satisfaction of the cosmetic results. Methods: Two hundred and forty metatarsal osteotomies (Wilson osteotomy as modified by Lindgren and Turan) were evaluated 4.19 ±1.29 years postoperatively. The procedure involved a slightly oblique subcapital osteotomy of the first metatarsal and fixation with one screw. Results: The average decrease in the hallux valgus angle was 26 ± 5 degrees, the 1–2 intermetatarsal angle was 8.4 ± 4 degrees, and the average shortening of the first metatarsal was 3.8 ± 1.8 mm. Positive correlations were found between metatarsalgia of the second through fourth rays and first ray shortening ( p < 0.001 second ray, p < 0.001 third ray, and p < 0.001 fourth ray); there was no correlation between the fifth ray and first ray shortening. No correlation was found between a decrease in the hallux valgus angle or 1–2 intermetatarsal angle and metatarsalgia in the second through fifth rays. A positive correlation was detected between postoperative foot alignment and decrease in the hallux valgus ( p < 0.001) and a negative correlation between postoperative foot alignment and first ray shortening ( p < 0.01). No correlation was noted between postoperative foot alignment and the 1–2 intermetatarsal angle. Conclusion: Excessive shortening of the first metatarsal should be avoided to decrease the occurrence of postoperative transfer metatarsalgia. We found a greater patient satisfaction with foot alignment in patients who had a greater decrease in the hallux valgus angle and less shortening of the first ray.

Purpose The RAY’ACT project is a nationwide program of multicentre surveys aimed at evaluating patient radiation protection (RP) for coronary angiography (CA) and percutaneous coronary interventions (PCI) in French non-university public hospitals, which represent > 30 % of the national activity for PCIs, and 60 % of the emergency cases. Methods In the second RAY’ACT survey, RP parameters from 48,547 CAs and 40,026 PCIs performed at 61 centres during 2013 (see Table 1 ) and routinely registered in professional software were extracted and analysed retrospectively. Dose × area product (DAP), fluoroscopy time (FT), number of registered frames (NF) and runs (NR), and total Air Kerma at interventional reference point (AK,r) were analysed separately for CAs and PCIs (elective and ad hoc pooled). All procedures of the year were included. Results Overall, a highly significant reduction in DAP of 20 %, and in AK,r and NF of 30 % was demonstrated for CA and PCI, while FT and NR decreased of 11 % and 5 %, respectively (all P Conclusions Between 2010 and 2013, a significant 20 to 30 % reduction was observed in medians and reference levels (Q3) for main RP parameters, including DAP, total Air Kerma, and number of registered frames, in diagnostic and interventional coronary procedures.

A new species of seven-spined goby of the genus Chriolepis is described from five specimens collected from the continental shelf of the northeastern Gulf of Mexico and Atlantic Ocean off South Carolina in depths of ca 54 to 110 m. The "Platform Goby", Chriolepis prolata, is distinguishable from all other western Atlantic species currently assigned to the genus Chriolepis and the morphologically similar genus Varicus in having pelvic-fin rays one through four branched, the fifth (innermost) pelvic-fin ray unbranched and relatively long (longer than the second ray to longer than all other pelvic-fin rays); most lateral body scales ctenoid, extending anteriorly in a wedge to a level anterior to the first dorsal-fin insertion or nearly to the pectoral-fin axil, with two or more rows of small cycloid scales extending anteriorly to near the pectoral-fin axil, cycloid scales along the bases of the dorsal and anal fins, and no scales on the belly; and the first two anal-fin pterygiophores inserted anterior to the first haemal spine. It closely resembles C. bilix but differs from that species which has a scaled belly, a shorter fifth pelvic-fin ray, prolonged dorsal-fin spines and smaller teeth in the lower jaw. An earlier report of C. bilix from Florida waters apparently refers to C. prolata.

Purpose To characterize in-shoe pressure measurements during different soccer-specific maneuvers on two playing surfaces to identify the main loading areas of the foot. Methods Twenty-one experienced male soccer players participated in the study (25.5 ± 1.8 years, 78.7 ± 5.4 kg, and 182.9 ± 5.7 cm). The Pedar Mobile system was used to collect plantar pressure information inside the soccer shoe. Four soccer-specific movements were performed (normal run, cutting maneuver, sprint, and goal shot) on both a grass and a red cinder surface. Results Results showed characteristic pressure distribution patterns with specific loading areas of the foot that correspond to the evaluated movements. In addition, loading patterns with higher pressure values than those observed during normal run were found. In cutting, the medial part of the foot; in sprinting, the first and second ray; and in kicking, the lateral part of the foot are predominantly loaded. No global effect of the two surfaces on pressure parameters was found. Conclusion The results of the present investigation suggest that the high load in soccer in combination with a high repetition may have an important influence in the development of overuse injuries.

s / Clinical Biomechanics 23 (2008) 662–720 679 alarms (one alarm per step and sensor when a given pressure threshold is surpassed), pressure per step, alarm per step, pressure per unit distance, alarms per unit distance.

Infections due to Mycobacterium terrae complex are rare. We report a severe case of chronic tenosynovitis and osteomyelitis of the hand caused by Mycobacterium nonchromogenicum requiring second ray finger amputation.

Members of the subfamily Lorisinae are characterized by a reduced second ray. When walking on branches, lorises grip the support with the second ray pointing in the direction of movement. This does not contribute to the grip of either the hand or the foot. The finger is hyperextended at the metacarpophalangeal joint, flexed at the proximal interphalangeal joint, and hyperextended at the distal interphalangeal joint. As a result, the palmar (volar) pad proximal to the second finger and the distal pad of the digit are pressed against the underlying support. The toe is sometimes placed on top of the third digit. The morphological and behavioral features have a mechanical basis. The orientation of the second ray in combination with the great stride length characteristic of these animals generates high stress in bones and tendons. Its reduction in length as well as its flexed posture during locomotion are means to avoid over stressing. Moments in the basal joints of fingers and metacarpals that must be counterbalanced by muscle action are also reduced. In the larger-bodied lorisine species bending stresses are higher than in the smaller ones: the reduction of the second ray is therefore more pronounced.

Andropodial and testicular development in a viviparous halfbeak, Dermogenys sp., is described from birth to sexual maturity. Gradual transformation of the anterior seven rays in the male anal fin takes place through the 9.0 mm-18.0 mm SL stages. Changes include an increase in number of segments in all rays, a thickening of rays 1-5, and marked curvature of rays 1-7. The 20.5 mm-26.0 mm stages are characterized by development of the tridens flexibilis, a pair of spines, and a hook, the spiculus, on the distal portion of the second anal-fin ray. Serrations also develop on the second and fourth fin rays. A mature andropodium possesses a pair of welldeveloped spines and a single, segmented, sickle-shaped spiculus on the second ray. Testicular maturation coincides with andropodial maturation. Throughout fin transformation, testes continue to develop. Male and female gonads are differentiated at birth. Within the testes, isolated spermatogonia proliferate through the 15.0-mm stage. By 18.0 mm, late-stage spermatogonia within spermatocysts are evident. By 20.5 mm, spermatocysts containing late spermatids are present. Sexual maturation, defined as presence of mature spermatozoa within testicular ducts, occurs at a length of 22.5 mm or greater. The testes of Dermogenys, which are typical atherinomorph testes, contain large, complete spermatozeugmata within the testicular ducts. These findings provide a morphological basis for identifying ontogenetic stages of the anal fin and for recognizing and comparing mature andropodia among species of Dermogenys for use in future phylogenetic analyses. T HE family Hemiramphidae, containing the

Microsurgical transfer of a compound osteo-cutaneous free flap derived from the dorsal foot skin and second ray can provide a satisfactory reconstruction for defects of the mandible and floor of the mouth. The procedure is particularly recommended for anterior segment losses where a thin flap and a curved skeleton is required. The flap can be prepared at the time of tumour resection without inconvenience to either surgical team and the surgery does not significantly affect either the operative or post-operative condition of the patient. No external bony fixation is required and no case of non-union has been encountered.

UNLABELLED On half and three-quarter points, the most frequent foot positions in dance, the metatarsals form an extension of the lower leg. In 54% of 56 professional male and female dancers whose feet were examined, this extraordinary stress leads to pronounced thickening of the cortex of the second metatarsal and in 6%, of the third metatarsal as well. There are no symptoms. Hypertrophy of the bone occurs in response to the additional stress imposed by dancing. Dancing on points is not the triggering factor, since male and female dancers are equally affected. COMPLICATIONS Under intensive stress of dancing, pain can develop in the medial portion of Lisfrans joint and endanger the dancer's career. Skeletal scintigraphy in such cases reveals increased metabolism of the bone at the base of the second metatarsal as well as in the cuneiforme intermedium. The development of this overstress on the second ray is favored by the following factors: Primarily by the congenital pes cavus which makes correct stressing of the foot in dancing impossible; a relatively long second metatarsal, or possibly the third metatarsal as well; - by an excessively large antetorsion angle of the neck of the femur, which makes correct positioning of the foot in the five positions of classical dance impossible; - by overstressing the half-points position in teaching, or by unfavorable training conditions, especially floors that are too hard. No treatment of these painful complications is possible if they are caused by anatomical factors. In other cases, several month's rest, changing ballet technique, and improved conditions regarding the ballet floor can result in an improvement. Even then, relapses are not infrequent, however.

Reconstruction of 15 thumbs in 14 patients with severe postburn deformity has been carried out by advancement and transferral of the second ray remnant onto the remaining proximal thumb metacarpal stump. This technique combines the advantages of thumb lengthening and pollicization procedures in a single operation and has been a useful method for restoration of single hand prehension in the severely burned mitten hand.

Wide barriers of a trapezoidal shape are investigated analytically and experimentally. The analytic model for the diffracted pressure is basedon the geometrical theory of diffraction. The incident ray is considered to undergo double diffraction, once at each of the edges of the two back‐to‐back wedges of the trapezoidal barrier. Thus, the second ray from first wedge to the second must graze the upper surface of the wide barrier. For the double diffraction calculations, the analytic solution for the diffraction by an absorbent single wedge, as originally developed by Malyuzhinets, is used. However, his solution breaks down on the surfaces of absorbent wedges. A correction solution was thus developed for rays that graze the surface of an absorbent wedge, facilitating a model for an absorbent wide barrier. Experiments on ⅕ scale models of hard and absorbent wide barriers were also conducted inside a gymnasium, where harmonic point sources as well as incoherent A‐weighted line noise sources were used. The prediction of the analytic models and the experimental data compare favorably for point to point propagation. [Work supported by National Cooperative Highway Research Program—National Research Council.]

IN view of Sir J. J. Thomson's suggestion (quoted by Reiche, “Quantentheorie,” p. 25) that the wave front of light may have a speckled structure, it may be asked whether anything peculiar happens when two specks, belonging to different waves, collide. They might, for example, be deviated from their courses. If so, one light wave would cause some scattering of another wave with which it collided, and the direct light in the second wave would be dimmed. This effect, if it exists at all, must be small or it would have been noticed. Evidence as to its existence might be obtained in the following way. The supposed dimming of the second ray would be likely to depend on the angle between it and the first ray. On this supposition the brightness of a star lying on the ecliptic would vary slightly with the angle between it and the sun, as seen from the earth. Russell (Astrophys. Journ., vol. xliii., 1916) has shown that the brightness of the moon does so vary, but that has been explained otherwise.

The author obtained, in the early part of last September, at Brixham, in Devonshire, seven specimens of a species of Gurnard, which has been known for thirty years past to the fishermen there under the name of Finned Captains. This he ascertained to be the Trigla lucerna of Brunner. The species is known as an inhabitant of the Mediterranean, where it was first noticed by Rondeletius, but mistaken by him for the T. cuculus of Linnæus. Since then, Brunner noticed it at Marseilles, Risso at Nice, Leach at Malta, and Cuvier at Naples; but it had not been previously observed by any naturalist on the British coasts. The largest specimen obtained by the author is 10½ inches long. The back is light red, the pectoral fins dark blue, the sides marked by a silvery band from the gill-cover to the tail; the lateral line smooth, and formed by numerous semicircular plates, beautifully radiated at their free margin ; the scales thin, large, and entire; the second ray of the first dorsal fin very long, so as to reach, when folded down, beyond the sixth ray of the second dorsal fin. (See Plate.)