Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Radiographic Evaluation of the Medial Part of Navicular Bone as Accessory Navicular or Prominent Navicular Tuberosity: Morphometrical Study
Os Navicularenin Medyal Kısmının Os Naviculare Accessorius ya da Tuberositas Ossis Naviculare Olarak Radyografik Değerlendirilmesi: Morfometrik Çalışma
Alev BOBUŞ ÖRSa, Zeliha KURTOĞLU OLGUNUSa, Volkan ÖZTUNAb
aDepartment of Anatomy, Mersin University Faculty of Medicine, Mersin, TURKEY
bDepartment of Orthopedics and Traumatology, Mersin University Faculty of Medicine, Mersin, TURKEY
Turkiye Klinikleri J Med Sci. 2021;41(3):313-9
doi: 10.5336/medsci.2020-80642
Article Language: EN
Full Text
ABSTRACT
 Objective: Accessory navicular (AN) is one of the most common accessory bones of the foot. It is classified into three types according to radiologic appearance. Also these types are divided into subgroups. It was difficult to distinguish the prominent navicular tuberosity from the Type IIIb AN as there was no criterion in the literature. Therefore, it is aimed to ensure morphometric data for the medial extension of AN. Material and Methods: In the present study, radiographs of 77 subjects were investigated in terms of AN presence and types. Widths and anteroposterior lengths of both native navicular and its medial extension were measured and data were evaluated statistically. Results: Type I and Type II AN bones were detected in 6 and 11 sides, respectively. While Type IIIb could not be discernable, Type IIIa and c were found in 3 sides. The width and anteroposterior length of native navicular bone were found significantly higher in men than in women (p=0.0001, p=0.018). But there was no statistically significant difference between sexes for the parameters of the medial extension (p=0.776, p=0.137). Dimensions of the medial bony extension didn't show significant differences in the presence or absence of AN (Type I, II, IIIa, c). Conclusion: In all cases, navicular tuberosity was exceeding the surgical reference line medially more or less. Knowledge about the diversity in morphometry of the exceeding part could be helpful for surgical procedures. To clarify this issue and as the discrimination criteria is not found sufficient, it is proposed to describe Type IIIb AN as an enormous sized tuberosity of native navicular rather than being an accessory bone.

Keywords: Accessory navicular; flat foot; navicular bone; posterior tibial muscle; prominent navicular tuberosity
ÖZET
 Amaç: Aksesuar naviküler (AN) kemik, ayakta sık karşılaşılan aksesuar kemiklerden biridir. Radyolojik görünümüne göre 3 tipte sınıflandırılmıştır. Ayrıca bunlar da alt tiplere ayrılmıştır. Ancak literatürde net bir kriter bulunmadığı için Tip IIIb AN'nin, belirgin tuberositas ossis naviculareden ayrımı tam olarak yapılamamıştır. Bu sebeple, bu çalışmada naviküler kemik ve medial uzantısına yönelik morfometrik veri sağlanması amaçlanmıştır. Gereç ve Yöntemler: Bu çalışmada, AN varlığını ve tiplerini belirlemek için 77 bireyin radyografileri incelendi. Normal naviküler kemiğin ve medial uzantısının genişlikleri ve ön-arka mesafeleri ölçüldü ve istatistiksel olarak değerlendirildi. Bulgular: Altı tarafta Tip I ve 11 tarafta Tip II AN tespit edilirken, Tip III (a ve c) ise 3 tarafta tespit edildi (Tip IIIb ayırt edilemedi). Normal naviküler kemiğin genişliği ve ön-arka uzunluğu, erkeklerde, kadınlara göre istatistiksel olarak daha yüksek bulundu (p=0,0001, p=0,018). Medial uzantı parametreleri için ise cinsiyetler arasında istatistiksel olarak anlamlı bir fark yoktu (p=0,776, p=0,137). Kemiğin medial uzantısının boyutları, AN (Tip I, II, IIIa, c) kemiğin var olup olmaması ile önemli bir değişim göstermiyordu. Sonuç: Tuberositas ossis naviculare, tüm olgularda az ya da çok cerrahi referans hattının medialinde yer alıyordu. Mediale taşan bu kısmın morfometrisi ile ilgili bilgilerin, cerrahi işlemler için faydalı olabileceği düşünüldü. Konuya açıklık kazandırmak için ve ayırt edici kriter yeterli görülmediği için Tip IIIb AN'nin, aksesuar bir kemik olmaktan ziyade, asıl kemiğin aşırı büyük bir uzantısı olarak tarif edilmesi önerildi.

Anahtar Kelimeler: Os naviculare accessoria; düz tabanlık; os naviculare; musculus tibialis posterior; tuberositas ossis naviculare
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