Highlights • There is no need to rush the treatment of foot polydactyly. • Allowing time for the foot to grow may help reveal the full deformity. • Most surgically treated polydactyly cases tend to ...do well in the long run.
The human spinal column underwent many significant changes over the 4.5 million years of our ancestral bipedalism. The main change, however, came with acquiring multiple curvatures in the sagittal ...plane. This alteration seems to have exposed a weakness in our body's keystone and made us susceptible to thus far unbeknown problems of the spine because it has been noted that idiopathic scoliosis has not been observed in other primates. Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine causing an imbalance of the trunk as it increases in magnitude. A scoliotic curve comprises three components, the coronal, sagittal, and axial so that each curve can affect the global balance of the body differently. Patients with significant scoliotic deformities often find themselves at a biomechanical disadvantage when it comes to energy expenditure and keeping an upright stance. The pioneers of scoliosis research recognized the need for describing and quantifying deformity to better understand it, so they first translated clinical measurements to radiographs and built from there. The development of concepts like defining a curve by its end vertebrae and measuring its magnitude, assessing global spinal balance, describing the stable zone, and pinpointing the stable vertebra all followed suit. The importance of sagittal balance and restoring sagittal parameters during treatment was emphasized. In a quest to bring order to chaos, some tried to classify various scoliotic curve types. These classifications helped steer treatment decisions but were found lacking in many aspects. So far, a widely accepted three-dimensional classification of scoliosis still does not exist. This review aims to provide the reader with an overview of the development of balance and imbalance concepts in scoliosis.
Abstract Osteochondritis dissecans (OCD) is a localized disorder of the joint surface by which a segment of subchondral bone and its overlying cartilage become fragmented. Arthroscopic treatment of ...OCD of the first metatarsophalangeal joint consisted mainly of debridement and loose body removal. The microfracture technique for the treatment of OCD of the first metatarsophalangeal joint is presented for the first time. The technique has been shown to be a safe and technically uncomplicated first-line treatment.
Cerebral palsy often carries a high risk of hip involvement, especially in patients with a higher degree of body involvement. Hip subluxations and dislocations are commonly seen in non-ambulatory ...patients. We report on a single skin incision anterolateral approach to the hip that provides excellent visualization of all relevant anatomical structures and allows for a broad range of operative procedures needed to complete the San Diego operation. From 2005 to 2020, 50 patients (56 hips) were treated using the San Diego procedure. There were 22 male and 28 female patients, with 28 dislocated and 28 subluxated hips. The average patient age at the time of surgery was nine (range, 4 – 22 years). A San Diego or Dega pelvic osteotomy was done in 49 hips, and seven hips underwent a Brunner-type pelvic osteotomy. The mean follow-up was seven years (range, 2 – 13 years). The median preoperative AI measured at 40° (range, 35° – 50°). The median postoperative AI at the time of the most recent follow-up was 22,5° (range, 5° – 40°). The average head migration index at the last follow-up was 10% (range, 0% – 60%). Two infections, three recurring adduction contractures, four redislocations, one fracture, and one pseudarthrosis were encountered. All patients were eventually able to sit pain-free, with significantly better sitting balance.
Os vesalianum (OV) is an accessory bone near the 5th metatarsal. It is usually asymptomatic, but might become painful.
Nineteen-year-old soccer player with bilateral OVs complained of right foot pain ...after exercise. MRI showed no findings that would explain symptoms with certainty. Bone scan with SPECT-CT showed abnormal metabolism in both OVs, while increased blood flow was seen only in the right OV, confirming the cause of pain. After surgical removal of right OV the patient was symptom-free.
Broad diagnostic workup should be performed in patients with disabling foot pain and presence of OV to avoid unnecessary surgery.
Os vesalianum (OV) ist ein akzessorischer Knochen nah an des Basis des fünften Mittelfußknochens. Es ist häufig asymptomatisch, es kann jedoch Schmerzen verursachen.
Ein 19-jähriger Fußballspieler mit beidseits bekannten Os vesalianum klagte über Schmerzen im rechten Fuß nach einer Trainingseinheit. Kernspintomographisch ergaben sich keine Befunde, die die Beschwerden erklären konnten. Die daraufhin durchgeführte SPECT-CT zeigte einen abnormalen Metabolismus der beiden OV, mit gesteigerter Durchblutung nur im Bereich des rechten OV, was die Ursache der Dolenz bestätigte. Nach chirurgischer Entfernung des OV war der Patient beschwerdefrei.
Bei Patienten mit immobilisierenden Fußschmerzen und vorbestehenden Os vesalianum ist eine ausführliche Diagnostik erforderlich um unnötige chirurgische Eingriffe zu vermeiden.
We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact physicians due to certain ...peculiarities of the immature immune system, small size and underdevelopment of joint anatomy. Data presented here are recent and significant, and something to bear in mind when caring for children of this age.
With the advent of new diagnostic methods, a shift in the causative agent of pediatric knee infections has been noted. Minimally invasive methods such as arthrocentesis and arthroscopy are successfully employed in treatment of knee problems in newborns and infants. A trial of conservative therapy in congenital patellar instability can give good results, and obviate the need for surgery in some cases. Various syndromes that affect the knee have specific characteristics that need to be recognized early to avoid problems in the future.
Although rare, knee problems in infants can and do occur. Their cause varies significantly and good outcomes require a multidisciplinary approach. Early diagnosis, referral and initiation of treatment protocols can significantly influence the fate of the joint and with it the patients' functional status for life.
Highlights • Malignant bone tumors represent one fifth of all primary bone lesions. • Estimated incidence of osteosarcoma is 1.68/million/year. • Incidences of chondrosarcoma and Ewing sarcoma are ...0.79 and 0.76, respectively. • More than 50% of patients with bone tumors are younger than 30 years. • There is no change in musculoskeletal tumor incidence during the last 30 years.
Proximal junctional kyphosis (PJK) is a major complication after posterior spinal surgery. It is diagnosed radiographically based on a proximal junctional angle (PJA) and clinically when proximal ...extension is required. We hypothesized that abnormal spinopelvic alignment will increase the risk of PJK in children with early-onset scoliosis (EOS).
A retrospective study of 135 children with EOS from 2 registries, who were treated with distraction-based implants. Etiologies included 54 congenital, 10 neuromuscular, 37 syndromic, 32 idiopathic, and 2 unknown. A total of 89 rib-based and 46 spine-based surgeries were performed at a mean age of 5.3±2.83 years. On sagittal radiographs, spinopelvic parameters were measured preoperatively and at last follow-up: scoliosis angle (Cobb method, CA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope and PJA. Radiographic PJK was defined as PJA≥10 degrees and PJA≥10 degrees greater than preoperative measurement. The requirement for the proximal extension of the upper instrumented vertebrae was considered a proximal junctional failure (PJF). Analysis of risk factors for the development of PJK and PJF was performed.
At final follow-up (mean: 4.5±2.6 y), CA decreased (P<0.005), LL (P=0.029), and PI (P<0.005) increased, whereas PI-LL (pelvic incidence minus lumbar lordosis) did not change (P=0.706). Overall, 38% of children developed radiographic PJK and 18% developed PJF. Preoperative TK>50 degrees was a risk factor for the development of radiographic PJK (relative risk: 1.67, P=0.04). Children with high postoperative CA hazard ratio (HR): 1.03, P=0.015, postoperative PT≥30 degrees (HR: 2.77, P=0.043), PI-LL>20 degrees (HR: 2.92, P=0.034), as well as greater preoperative to postoperative changes in PT (HR: 1.05, P=0.004), PI (HR: 1.06, P=0.0004) and PI-LL (HR: 1.03, P=0.013) were more likely to develop PJF. Children with rib-based constructs were less likely to develop radiographic PJK compared with children with spine-based distraction constructs (31% vs. 54%, respectively, P=0.038).
In EOS patients undergoing growth-friendly surgery for EOS, preoperative TK>50 degrees was associated with increased risk for radiographic PJK. Postoperative PI-LL>20 degrees, PT≥30 degrees, and overcorrection of PT and PI-LL increased risk for PJF. Rib-based distraction construct decreased the risk for radiographic PJK in contrast with the spine-based constructs.
Level III.
Konzervativno liječenje skolioze uključuje nošenje korektivne ortoze u propisanom vremenu, nerijetko potpomognuto režimom fizikalne terapije. Djelotvornost liječenja ortozom dokazana je brojnim ...kliničkim ispitivanjima te predstavlja “zlatni standard” konzervativnog liječenja. Suradnja bolesnika u liječenju ortozom bît je uspješnosti tretmana. Liječenje je učinkovito samo u vrijeme rasta, a najčešće se odvija u periodu adolescencije. Adolescencija je psihološki vrlo burno razdoblje pa suradnja s adolescentnim bolesnikom može biti otežana iz više razloga. Zato je važno razumijevanje i uvažavanje psihosocijalnih aspekata u liječenju ove skupine bolesnika, kao i razumijevanje i uvažavanje dinamike cijele obitelji. Unaprjeđivanje suradnje važno je za tijek i ishod liječenja, a postupci unaprjeđivanja suradnje i pružanja psihološke potpore trebaju biti kontinuirani i strukturirani. Bolesnici koji dobivaju adekvatnu psihološku potporu koja uključuje i edukaciju o važnosti tretmana bolje surađuju te se općenito bolje osjećaju od onih bolesnika koji navedenu potporu nisu primili.
Highlights • PVNS of the ankle is seen more often than reported. • Ankle complaints warrant a structured diagnostic algorithm. • Arthroscopy is an excellent option for treating LPVNS of the ankle ...joint. • Complete resection of the altered synovial tissue is paramount to avoid recurrence. • Pathohistological examination has the final say in determining the diagnosis.
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