Results of a Standard versus an Accelerated Ponseti Protocol for Clubfoot: A Prospective Randomized Study

BACKGROUND: The aim of this study was to compare the results of the standard once-weekly Ponseti casting technique to an accelerated twice-weekly regimen in our population cohort.METHODS: A prospective randomized controlled study was conducted with a total of 100 consecutive patients (158 feet) being enrolled for the study. Fifty patients were randomized to each group and followed up for at least one year.RESULTS: Initial mean Pirani score was 4.67 ± 0.73 in the standard group and 4.35 ± 0.76 in the accelerated group, and the score decreased to 0.34 ± 0.38 and 0.35 ± 0.31, respectively. Initial mean Dimeglio score was 11.75 ± 2.75 in the standard group and 10.51 ± 2.57 in the accelerated group, and the score decreased to 0.79 ± 0.77 and 0.79 ± 0.71, respectively, immediately after casting. The average number of casts required to correct all the deformities was 6.3 ± 1.2 in the standard group and 6.1 ± 1.4 in the accelerated group (p = 0.45). Average time spent in cast was 58.2 ± 8.3 days in the standard group and 39.5 ± 5.2 days in the accelerated group (p < 0.001). Percutaneous Achilles tendon tenotomy was done in 86.42% in the standard group and in 84.41% in the accelerated group (p = 0.72). Final results were assessed by using a modified functional rating scoring system: 55.55% clubfeet had excellent results and 44.45% had good results in the standard group, whereas 66.23% clubfeet had excellent results and 33.77% had good results in the accelerated group. None amongst the two groups had fair or poor results.CONCLUSIONS: These results suggest that the accelerated Ponseti technique significantly reduces the correction time without affecting the final results and that it is as safe and effective as the traditional Ponseti technique.

The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.

Papuloerythroderma of Ofuji - a case report

Papuloerythroderma of Ofuji is an uncommon skin condition seen in elderly patients characterized by pruritic eruption of infiltrating papules with sparing of large folds of skin. Very few cases have been reported in the literature and the frequent association of this rare entity with laboratory abnormalities and malignancy points towards its heterogenous nature. We report a case of Papuloerythroderma of Ofuji having peripheral eosinophilia but not associated with any malignancy

Lipoid proteinosis: case report and a brief review

Lipoid proteinosis is a rare, autosomal recessive disorder, characterized by infiltration of periodic acid-Schiff positive hyaline material into the skin, oral cavity, larynx and internal organs. The clinical manifestations include hoarseness of voice, beaded papules along the eyelid margins, skin scarring and an inability to protrude the enlarged and thickened tongue. In this paper, we present a case of a young male with features suggestive of lipoid proteinosis. Clinical rarity of this condition prompted this communication

case of granuloma faciale

A 60-year-old housewife reported with a raised red lesion on the left cheek since the last four months. Local examination revealed a well-defined erythematous indurated plaque 3x3 cm[2] with geographical borders on the left cheek close to the angle of mouth. Routine investigations were normal. Histopathology revealed loosely scattered granulomas in the dermis with lymphocytes, plasma cells, neutrophils and eosinophils. A disease free Grenz zone was seen. A diagnosis of granuloma faciale was made and the patient was put on intralesional steroid therapy. She continues to be on regular follow up