Diagnosis and treatment of congenital oblique talus in infants / 中国矫形外科杂志

[Objective] To investigate the diagnosis and treatment of congenital oblique talus in clinical practice.[Methods]Clinical situation of thirty-one patients displayed tarsoptosis and pas valgus,collapse in medial longitudinal instep,and with no talipes calcaneus,no contraction of tendon and no rigidity.All instep of the patients were restored to normal by chirismus.The X-ray of normotopia showed that axial ray of talus was declivent to wall and was angulated with No.1 metatarsal bones.The X-ray of lateral position showed that semiluxation of articulatio talonavicularis was noted,and axial ray of talus and No.1 metatarsal bones was not normal.The X-ray of lateral position of maximal plant flex and entropion showed that axial ray of talus and No.1 metatarsal bones was normal.Twenty-seven cases were cured by manipulation,4 cases were cured by operation,31 cases were cured by orthopaedic orthosis.[Results]All cases were curative during a follow-up of 12 to 24 months(mean,10 months).All outline forms of feet were good and no valgus calcaneus was found,the medial longitudinal instep were restored,the function of ankle and toes was normal,and the pedal force of enstrophe with ecstrophy was balance.The X-ray of normotopia showed that the angle of axial ray of talus to No.1 metatarsal bones was normal in 26 cases and ≤10? in 5 cases.Kite's angle was normal in 29 cases and ≤20? in 2 cases.The X-ray of lateral position showed that articulatio talonavicularis was good in 29 cases and ≤25? of talus to calcaneus in 6 cases.[Conclusion]Congenital oblique talus in infants can be cured by manipulation or operation.The prognosis is good.

Analysis about reason of congenital infantile coxa vara being misdiagnosed as infantile dislocation of hip join / 中国矫形外科杂志

[Objective]To analyze reason of congenital infantile coxa vara to be misdiagnosed as infantile dislocation of hip joint.[Method]There were 6 patients(6 hip join)congenital infantile coxa vara being misdiagnosed as infantile dislocation of hip join in 54 patients(73 hip join)and treated by expectant treatment as infantile dislocation of hip join.The curative effect of 6 patients were not good,after serious medical examination,careful reading image data,paying attention to curative effect,6 patients were confirmed to be diagnosed as infantile dislocation of hip join and not infantile dislocation of hip join.[Result]The features for diagaosis of congenital infantile coxa vara were:the big greater trochanter of femur and its position moving up,short spacious neck of femur,spacious medial blank in hip joint,superposed neck of femur and lesser trochanter of femur,praeter propter exponent of acetabulum,acceptable succession of Shenton’s line,enlarged angle of femoral head epiphysis,late center of ossification,incorporated abnormity such as breves femoral bone,bowing of femoral bone,abortive clavicle and bones of cranium,equines.[Conclusion]The second center of ossification of femoral head is appeared 6～9 monthes after birth,and it is difficult to discriminate congenital infantile coxa vara and infantile dislocation of hip join before this.Early to realize symptom,physical sign and character of image of congenital infantile coxa vara is significant for correct diagnosis and can avoid misdiagnosis and mistreatment.

Treatment of congenital vertical talus in infants by minimally invasive release operation / 中国矫形外科杂志

[Objective]To evaluate the application value of minimally invasive release operation about congenital vertical talus(CVT).[Method]All operation were operated with single method by author.Firstly,Achilles tendon,capsulotomy of the ankle and subtalar joint were released through a small straight posterior inside of Achilles tendon end point.Secondly,astragaloscaphoid and subtalar front joint were released bluntly through a straight posterior incision.Thirdly,based on circs subtalar joint were released through calcaneocuboid articulation outside foot.Then one K-wire were passed through the body of talus from its axis,and passed through instep after reposition of astragaloscaphoid joint.Two K-wires was passed through calcaneus to talus from planta.[Result]Eight cases were available for follow-up from 17 to 36 months(mean,28 months),follow-up results was evaluated by using a version of Adelaar and Kodros score,there were excellent result in 1 foot,good in 5,fair in 2.The presence of hindfoot valgus and forefoot abduce were noted in one foot,forefoot pronation was appeared in one foot.Two parameters-talar and calcaneus axis-first metalarsal base angles,calcaneus talus angles of eutopic and lateral radiograph were basally normal.[Conclusion]Operative reduction has been advocated as the only effective treatment for CVT,it is the best choice to use minimally invasive release operation for infant.