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15.3 Tibia (Figures 15.10–15.15)

15.3.1 Anatomy

The tibia is the major weight-bearing bone of the lower leg. It articulates proximally with the distal femur, twice laterally with the fibula (once proximally and once distally), and distally with the talus.

The tibial plateau is the proximal tibial surface on which the femur rests. It is divided into two articular sections, one for each femoral condyle. In life there are fibrocartilagenous rings around the periphery of these articular facets, the medial and lateral menisci.

The medial condyle is the medial part of the tibial plateau. Its femoral articulation is oval, with the long axis oriented anteroposteriorly. Its lateral edge is straight.

The lateral condyle is the lateral part of the tibial plateau. Its femoral articulation is smaller and rounder than the medial articulation.

The intercondylar eminence is the raised area on the proximal tibial surface between articular facets.

The medial intercondylar tubercle forms the medial part of the intercondylar eminence.

The lateral intercondylar tubercle forms the lateral part of the intercondylar eminence. The anterior and posterior cruciate ligaments and the anterior and posterior extremities of the menisci insert into the nonarticular areas between the condyles, which are just anterior and posterior to the medial and lateral intercondylar tubercles, respectively.

The superior fibular articular facet is located on the posteroinferior edge of the lateral condyle.

The tibial tuberosity is the rugose area on the anterior surface of the proximal tibia. Its superior part is smoothest and widest. The patellar ligament of the quadriceps femoris muscle, a major lower leg extensor at the knee, inserts here.

The tibial shaft is the fairly straight segment of the tibia between the expanded proximal and distal ends.

The soleal (popliteal) line crosses the proximal half of the posterior tibial surface from superolateral to inferomedial. The line demarcates the inferior boundary of the popliteus muscle insertion. This muscle is a flexor and medial rotator of the tibia and originates from the popliteal groove on the lateral femoral condyle. The line itself gives rise to the popliteus fascia and soleus muscle, a plantarflexor of the foot at the ankle.

The nutrient foramen is just inferolateral to the popliteal line. It is a large foramen that exits the bone proximally.

The anterior surface (anterior crest) of the shaft forms the anterior edge of the “shin.”

The medial surface of the shaft forms the medial edge of the “shin” of the lower leg. This subcutaneous border is the widest tibial shaft surface.

The interosseous surface of the shaft is lateral, opposite the fibula. It is the most concave of the three tibial surfaces.

The interosseous crest is the lateral crest of the shaft, which faces the fibula. It is the attachment area for the interosseous membrane, a sheet of tissue that functions to bind the tibia and fibula together and to compartmentalize lower leg muscles into anterior and posterior groups, just as its serial homolog does in the forearm.

The medial malleolus is the projection on the medial side of the distal tibia that forms the subcutaneous medial knob at the ankle. Its lateral surface is articular, for the talar body.

The fibular notch is the distolateral corner of the tibia. It is a triangular nonarticular area for the thick, short interosseous tibiofibular ligament. This ligament binds the distal tibia and fibula together as a unit at this syndesmosis. The proximal ankle, or talocrural, joint is formed by the tightly bound distal tibia and fibula, which articulate with the superior, medial, and lateral talar surfaces.

The inferior fibular articular surface is a thin articular surface for the fibula, which faces laterally at the base of the fibular notch.

The malleolar groove on the posterior aspect of the medial malleolus transmits the tendons of the tibialis posterior and flexor digitorum longus muscles, plantarflexors.

15.3.2 Growth (Figure 15.7)

The tibia ossifies from three centers: one for the shaft and one for each end of the bone. Separate centers for the tibial tuberosity sometimes occur.

15.3.3 Possible Confusion

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The triangular tibial cross section differentiates fragments of this bone from the femur or the much smaller humerus. The tibial shaft is much larger than radial or ulnar shafts.

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Proximal and distal ends of the tibia are diagnostic, and the only possibility of confusion arises in mistaking a segment of the proximal articular surface for the body of a vertebra. The articular surface of the tibia is much denser and smoother than the articular surface of a vertebral body.

15.3.4 Siding

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For an intact tibia, the tibial tuberosity is proximal and anterior. The medial malleolus is on the distal end and is medial.

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For the proximal tibia, the tibial tuberosity is anterolateral, the fibular articulation is placed posterolaterally, and the lateral femoral articular surface is smaller, rounder, and set laterally. The intercondylar eminence is set posteriorly, and the axis of the nonarticular strip on the plateau runs from anterolateral to posteromedial. This strip is wider anteriorly than posteriorly. The intercondylar eminence has a more concave medial border and a more evenly sloping lateral border.

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For fragments of shaft, the entire shaft tapers distally, and the interosseous crest is lateral and posterior. The medial surface is the widest and faces anteriorly. The nutrient foramen is posterior and exits proximally. The cortex is thickest at midshaft.

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For the distal end, the malleolus is medial and its distal-most projection is anterior. Grooves for the plantarflexor tendons are posterior. The fibular notch is lateral, and the interosseous crest runs toward its anterior surface. The margin of the articular surface for the superior talus is grooved on the anterior surface but not the posterior surface.

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Anatomic Considerations

The osseous structures of the gaskin region of the horse include the tibia and fibula. The tibia is a strong tubular bone that has a proximal triangular-shaped cross section that changes to an oval shape oriented lateromedially as it courses distad.¹ The tibia is the major weight-bearing bone of the gaskin and transfers weight from the femur to the talus. The tibial crest, located at the proximal cranial end of the bone, contains a deep muscular sulcus, which is filled by the peroneus tertius and long digital extensor muscles. The proximal articular surface of the tibia has a flat table surface with a centrally located intercondylar eminence. The distal articular surface has an undulating shape and contains two deep sulci oriented in caudomedial-to-craniolateral direction, which articulate with the trochlear ridges of the talus. For details on the complex soft tissue attachments between the tibia and both the femur and the tarsus, see Chapters 99 and 101.¹

The fibula is a rudimentary bone of variable shape and completeness. In most cases the fibula is incomplete and consists of several centers of ossification that can be mistaken for fibular fractures.¹ Rarely, an atavistic complete fibula is identified radiographically in a pony or Miniature horse foal (see Figure 87-19). The pathology associated with this condition creates limb deformities and tarsal osteoarthritis (see Chapter 87). Other than traumatic injury, this is the only condition in which lameness is associated with the fibula.

Other than lacerations, the most common injuries of the tibial region are fractures.² Stress fractures in the tibia in training horses are the most common. In addition, traumatic fractures of the tibia in the horse occasionally occur. Two types of unstable tibial fractures are commonly seen: the proximal physeal fracture, and the diaphyseal fracture.

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Anatomic Considerations

The osseous structures of the gaskin region of the horse include the tibia and fibula. The tibia is a strong tubular bone that has a triangular-shaped cross section proximally that changes to an oval shape oriented lateromedially as it courses distad.¹ The tibia is the major weight-bearing bone of the gaskin and transfers forces from the femur to the talus. The tibial crest, located at the proximal cranial end of the bone, contains a deep muscular sulcus, which is filled by the cranial tibial and long digital extensor muscles. The proximal articular surface of the tibia has a flat table surface with a centrally located intercondylar eminence. The distal articular surface has an undulating shape and contains two deep sulci oriented in caudomedial-to-craniolateral direction, which articulate with the trochlear ridges of the talus. For details on the complex soft tissue attachments between the tibia and both the femur and the tarsus, see Chapters 97 and 99Chapter 97Chapter 99.¹

The fibula is a rudimentary bone of variable shape and completeness. In most cases the fibula is incomplete and consists of several centers of ossification that can be mistaken for fibular fractures.¹ Rarely, an atavistic complete fibula is identified radiographically in a pony or Miniature Horse foal (see Figure 86-21). The pathology associated with this condition creates limb deformities and tarsal osteoarthritis (see Chapter 86). Other than traumatic injury, this is the only condition in which lameness is associated with the fibula.

Other than lacerations, the most common injuries of the tibial region are fractures. Stress fractures in the tibia in training horses are the most common. In addition, traumatic fractures of the tibia in the horse occasionally occur. Two common types of unstable tibial fractures are seen: the proximal physeal fracture and the diaphyseal fracture.

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12.3 Tibia (Figures 12.11–12.17)

12.3.1 Anatomy

The tibial plateau is the proximal tibial surface on which the femur rests. It is divided into two articular sections, one for each femoral condyle. In life there are fibrocartilaginous rings around the periphery of these articular facets, the medial and lateral menisci.

The medial condyle is the medial part of the tibial plateau. Its femoral articulation is oval, with the long axis oriented anteroposteriorly. Its lateral edge is straight.

The lateral condyle is the lateral part of the tibial plateau. Its femoral articulation is smaller and rounder than the medial articulation.

The intercondylar eminence is the raised area on the proximal tibial surface between articular facets.

The medial intercondylar tubercle forms the medial part of the intercondylar eminence.

The lateral intercondylar tubercle forms the lateral part of the intercondylar eminence. The anterior and posterior cruciate ligaments and the anterior and posterior extremities of the menisci insert into the nonarticular areas between the condyles, which are just anterior and posterior to the medial and lateral intercondylar tubercles, respectively.

The anterior intercondylar area is the nonarticular area on the tibial plateau anterior to the intercondylar eminence. It serves as an attachment site for the anterior cruciate ligament and the anterior ends of both menisci.

The posterior intercondylar area is the nonarticular area posterior to the intercondylar eminence. It serves as an attachment site for the posterior cruciate ligament and the posterior ends of both menisci.

The superior fibular articular facet is located on the posteroinferior edge of the lateral condyle.

The groove for the semimembranosus is an anteroposteriorly elongated hollow on the medial side of the medial condyle.

The tibial tuberosity is the rugose area on the anterior surface of the proximal tibia. Its superior part is smoothest and widest. The patellar ligament of the quadriceps femoris muscle, a major lower leg extensor at the knee, inserts here.

The tibial shaft (or body) is the fairly straight segment of the tibia between the expanded proximal and distal ends. The shaft is divided into three named surfaces by three named borders (or margins).

The medial surface of the shaft forms the medial edge of the “shin” of the lower leg. This subcutaneous, anteromedially facing surface is the widest tibial shaft surface.

The posterior surface runs along the entire length of the shaft. The broad, flat area/ portion of the posterior surface closest to the knee is often called the popliteal surface, although it is still part of the posterior surface. The soleal (or popliteal) line runs across the popliteal surface.

The lateral (or interosseous) surface of the shaft lies opposite the fibula. It is the most concave of the three tibial surfaces.

The medial border (or margin or crest) is the blunt edge running along the medial side of the shaft. It is the one of the three crests that give much of the tibial shaft its prismatic outline, and it serves as the attachment site of the deep transverse fascia.

The anterior border (or margin or crest) of the shaft forms the anterior edge of the “shin.” It is the most prominent of the three crests that give much of the tibial shaft its distinctive prismatic (triangular) outline.

The interosseous border (or margin or crest) is the lateral crest of the shaft, which faces the fibula. It is the last of the three main crests of the tibial shaft, and it is the attachment area for the interosseous membrane, a sheet of tissue that functions to bind the tibia and fibula together and to compartmentalize lower leg muscles into anterior and posterior groups, just as its serial homolog does in the forearm.

The soleal (or popliteal) line crosses the proximal one-third to one-half of the posterior tibial surface from superolateral to inferomedial. The line demarcates the inferior boundary of the popliteus muscle insertion. This muscle is a flexor and medial rotator of the tibia and originates from the popliteal groove on the lateral femoral condyle. The line itself gives rise to the popliteus fascia and soleus muscle, a plantarflexor of the foot at the ankle.

The nutrient foramen is just inferolateral to the popliteal line. It is a large foramen that exits the bone proximally.

The vertical line arises just inferior to the soleal (or popliteal) line and divides the posterior surface roughly in half. It marks the boundary between the origins of the tibialis posterior and flexor digitorum longus muscles.

The medial malleolus is the projection on the medial side of the distal tibia that forms the subcutaneous medial knob at the ankle. Its lateral surface articulates with the talar body. The medial malleolus is comprised of two rounded, hill-like prominences: the larger anterior colliculus and the smaller posterior colliculus.

The intercollicular groove separates the anterior and posterior colliculi. The groove and both colliculi serve as attachment sites for the apex of the deltoid ligament.

The anterior groove is a short but pronounced horizontal groove on the anterior aspect of the distal shaft, immediately superior to the talar articular surface.

The fibular notch is the distolateral corner of the tibia. It is a triangular nonarticular area for the thick, short interosseous tibiofibular ligament. This ligament binds the distal tibia and fibula together as a unit at this syndesmosis. The proximal ankle, or talocrural, joint is formed by the tightly bound distal tibia and fibula, which articulate with the superior, medial, and lateral talar surfaces.

The distal fibular articular surface is a thin articular surface for the fibula, which faces laterally at the base of the fibular notch.

aa.

The posterior (or malleolar) groove on the posterior aspect of the medial malleolus transmits the tendons of the tibialis posterior and flexor digitorum longus muscles, both plantarflexors.

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The groove for the flexor hallucis longus is a shallow groove found on the distalmost portion of the posterior tibia. It is less pronounced than the posterior (or malleolar) groove.

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The talar articular surface is composed of both the saddle-shaped, inferior-facing (superior) talar surface and the much smaller medial talar surface.

12.3.2 Growth (Figure 12.7)

The tibia ossifies from three centers: the diaphysis, the proximal epiphysis (including the tibial tuberosity), and the distal epiphysis. The primary center of ossification in the diaphysis appears appears at about 7–8 weeks (in utero). The secondary ossification center in the proximal epiphysis appears at 36 weeks (in utero) to 2 months (postnatal). It begins to fuse to the diaphysis at 13–17 years in females, and at about 15–19 years in males. The ossification center in the tibial tuberosity appears at 8–12 years in females and at about 9–14 years in males. The tibial tuberosity begins to fuse to the proximal epiphysis at about 12–14 years in both sexes. The secondary ossification center in the distal epiphysis appears at 3–10 months. It begins to fuse to the diaphysis at 14–16 years in females and at about 15–18 years in males (Scheuer and Black, 2000).

12.3.3 Possible Confusion

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The triangular tibial cross section differentiates fragments of this bone from the femur or the much smaller humerus (see cross sections in Chapter 14). The tibial shaft is much larger than radial or ulnar shafts.

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12.3.4 Siding

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For an intact tibia, the tibial tuberosity is proximal and anterior. The medial malleolus is on the distal end and is medial.

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For fragments of the shaft, the entire shaft tapers distally, and the interosseous border is lateral and posterior. The medial surface is the widest surface and faces anteriorly. The lateral surface is the most concave surface. The nutrient foramen is posterior and exits proximally. The cortex is thickest at midshaft.

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For the distal end, the malleolus is medial and its distalmost projection is anterior. Grooves for the plantarflexor tendons are posterior. The fibular notch is lateral, and the interosseous border runs toward its anterior surface. The margin of the articular surface for the superior talus is grooved on the anterior surface but not the posterior surface. The anterior colliculus is larger than the posterior colliculus.

12.3.5 Tibial Measurements (Figure 12.17)

Measurements of the tibia are used for stature estimation, age estimation, sex determination, gait reconstruction, biomechanical load calculations, and other analyses.

Maximum tibial length (Martin, 1928: 1049, #1a; Buikstra and Ubelaker, 1994: 83, #69): The maximum length that can be measured between the top of the intercondylar eminence and the bottom of the medial malleolus. Measured with an osteometric board.

Tibial biomechanical length (Trinkaus et al., 1999: 757): Using a large sliding caliper, place the tip of the stationary jaw on the centerpoint of the talar articular surface, and then measure the distances to: 1) the centerpoint of the medial condyle; and 2) the centerpoint of the lateral condyle. Biomechanical length is the average of these two distances.

Tibial maximum proximal epiphyseal breadth (Buikstra and Ubelaker, 1994: 83, #70): Using sliding calipers or an osteometric board, determine the maximum distance between the medialmost and lateralmost points of the tibial plateau.

Tibial maximum distal epiphyseal breadth (Buikstra and Ubelaker, 1994: 83, #71): Using sliding calipers or an osteometric board, determine the maximum distance between the medialmost point on the medial malleolus and the lateralmost point on the distal epiphysis.

Tibial midshaft circumference (Martin, 1928, 1050, #10): Determine the location of midshaft (preferably using 50% of tibial biomechanical length) and use a flexible cloth tape to determine the minimum circumference at that location.

Tibial circumference at nutrient foramen (Martin, 1928, 1050, #10a; Buikstra and Ubelaker, 1994: 83, #74): With a flexible cloth tape, measure the minimum circumference at the level of the nutrient foramen.

Tibial anteroposterior midshaft diameter (Martin, 1928, 1050, #8): Determine the location of midshaft (preferably using 50% of tibial biomechanical length) and use a sliding caliper to determine the anteroposterior diameter at that location.

Tibial mediolateral (or transverse) midshaft diameter (Martin, 1928, 1050, #9): Determine the location of midshaft (preferably using 50% of tibial biomechanical length) and use a sliding caliper to determine the mediolateral diameter at that location.

Tibial maximum shaft diameter at nutrient foramen (Martin, 1928, 1050, #8a; Buikstra and Ubelaker, 1994: 83, #72): With the bone in anatomical position and the sliding caliper in a parasagittal plane, measure the greatest distance from the anterior border to the posterior surface at the level of the nutrient foramen.

10.

Tibial mediolateral (or transverse) shaft diameter at nutrient foramen (Martin, 1928, 1050, #9a; Buikstra and Ubelaker, 1994: 83, #73): With the bone in anatomical position and the sliding caliper in a paracoronal plane, measure the maximum mediolateral dimension of the shaft at the level of the nutrient foramen.

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Platycnemic index (Martin, 1928: 1052): (mediolateral shaft diameter at nutrient foramen ÷ maximum shaft diameter at nutrient foramen) × 100.

12.3.6 Tibial Nonmetric Traits

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Tibial squatting facet: In individuals who habitually spend time in an extremely dorsiflexed position (e.g., sitting in a deep squatting position), a pair of conforming facets may form on the approximated anteroinferior tibia and anterosuperior talus. The tibial facet is usually scored as 0 (absent) or 1 (present).

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Platycnemia (or saber shins): In some individuals, the tibia may be noticeably flattened mediolaterally, a condition called platycnemia. A platycnemic tibia is one which has a platycnemic index of less than 63 (Bass, 2005).

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Tibial bowing: There are three types of tibial bowing, each characterized by the direction to which the apex of the bowing points: anterolateral, anteromedial, and posteromedial. Note the direction of the most severe degree of bowing and score it as 1 (straight), 2 (slight), 3 (moderate), or 4 (marked).

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Tibia

The patient is positioned in dorsal recumbency with the stifle flexed at a right angle. The proximal approach is performed on the medial aspect of the proximal tibia over the medial collateral ligament and slightly extended proximally to the medial aspect of the stifle joint (Fig. 5). The pin is then inserted along the medial border of the patellar ligament, entering the proximal end of the tibia between the cranial surface of the tibial tuberosity and the medial condyle of the tibia.¹⁰

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Fractures

Traumatic fractures of the tibia are commonly seen. The tibia is a long straight bone with little soft tissue covering. It is longer than the femur, and the fibula is virtually nonexistent.¹⁸ Tibial fractures are usually either transverse or short spiral fractures. Tibial fracture often occurs when a chinchilla is grabbed by its hind limb or a hind limb catches in a cage bar. Like the bones of rabbits, those of chinchillas are thin and fragile; surgical repair can be difficult and complications are common (see Chapter 33). Soft, padded bandages and lateral splints usually do not provide adequate stability for tibial fractures to heal.⁵⁴ External fixation and intramedullary pins, alone or in combination, have been recommended for surgical stabilization of tibial fractures in chinchillas.³⁸ Restricted exercise in a single-level enclosure, ideally without cage bars, is necessary. The prognosis for tibial fractures is guarded and complications after surgical fixation are common. These include bone-pin loosening and infection, nonunion, necrosis of the distal limb, and automutilation.³⁸ Consider hind-limb amputation if surgical fracture stabilization fails or is not indicated. Chinchillas usually adapt very well after amputation.^26,70,130 Fractures of the fore limbs distal to the elbow can be managed by external cooptation and splinting; chinchillas usually tolerate such treatment well.

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Tibia/Fibula

In our experience, tibial fractures are common in small mammals, particularly in guinea pigs and chinchillas (see Table 33-1). Depending on the location and degree of displacement, these may be amenable to external coaptation (see Fig. 33-1). The area of the proximal tibia in small mammals, particularly rodents, is characterized by an abrupt change in the diameter of the limb distal to the stifle. This makes it difficult to properly apply splints to the lower limb. Additional padding is needed for the bandage to be cylindrical. If the splint is not placed far enough proximally (at least to the distal third of the femur), the splint may slip distally and act as a fulcrum at the fracture site. A lateral-cranial splint or a combination of caudolateral splint may be applied.

Anatomic Considerations

Avoid the saphenous artery, vein, and nerve on the medial aspect.

Types of Fixation

For fixation, IM pins can be inserted normograde from the cranial aspect of the tibia, on the tibial crest. Type Ia external fixators may be applied medially and may be used in conjunction with an IM pin (Fig. 33-5). Generally, type II fixators are not required for stabilization. Plates are difficult to use because of the thinness of the bone in most small mammals as well as the lack of good soft tissue coverage.

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Fractures

Traumatic fractures of the tibia are commonly seen. The tibia is a long, straight bone with little soft tissue covering. It is longer than the femur, and the fibula is virtually nonexistent (Fig. 25-3). Tibial fractures are usually either transverse or short spiral fractures, and they usually are associated with bony fragments. Fractures commonly occur when a chinchilla is grabbed by its hind limb or catches its leg in a cage bar.

Like the bones of rabbits, those of chinchillas are thin and fragile, and surgical repair can be difficult (see Chapter 35). Soft, padded bandages and lateral splints usually do not provide adequate stability for fractures to heal.³¹ Although intramedullary fixation has been used,⁷¹ the effect of the pin on the thin cortices and narrow lumen can result in microstructural damage that leads to excessive bone resorption and premature pin loosening. For best results, surgically repair the fracture with either wire or external fixators (type II Kirschner-Ehmer apparatus) and then stabilize it with bandages.⁴⁷

Chinchillas are active animals, and limiting mobility by placing the animal in a small cage is essential for fracture healing. Unfortunately, frequent visits to the veterinarian to reset the fracture are common. Advise owners that nonunion is a possible outcome and will result in a crooked leg. Should a limb need to be amputated, chinchillas usually adapt extremely well.

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Schematic of a CCD indirect digital detector. The x-rays strike a scintillator material that produces light. The light is then focused via an optical coupling device before reaching the CCD. As with other types of digital systems, this analog (electrical) signal is converted to a digital signal for display.

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12.3.6 Tibial Nonmetric Traits

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