Fracture in Humeroradial Synostosis: Description of Two Clinical Cases / Fratura em sinostose rádio-umeral: Descrição de dois casos clínicos*

Abstract Synostosis is a generic term to indicate the union of two originally separated bones. At the elbow, humeroradial or longitudinal synostosis causes significant disability, which varies depending on hand function, elbow positioning, adjacent joints mobility and contralateral limb function. It is estimated that, to date, a little more than 150 patients have been described with this deformity, which is more common in subjects with deficient ulnar formation or affected by conditions such as Antley-Bixler and Hermann syndromes. The lack of the elbow joint, with the formation of a longer bone due to humerus-radius fusion, results in stiffness. As such, it is assumed that fractures in this topography are not uncommon. However, since synostosis is rare, this lesion was only described twice in the literature. We report two patients with a fracture of the single bone formed by a humeroradial synostosis and Bayne type-IV ulnar formation failure. Both patients were treated surgically with success. We emphasize the need for adequate treatment to not compromise the daily activities of patients who are adapted to their deformity, thus avoiding worsening the function of a previously affected limb.

Resumo Sinostose é um termo genérico utilizado para indicar a união de dois ossos originalmente separados. No cotovelo, a sinostose rádio-umeral ou longitudinal causa importante incapacidade, que varia a depender da função da mão, da posição do cotovelo, da mobilidade das articulações adjacentes e da função do membro contralateral. Estima-se que um pouco mais de 150 pacientes foram descritos até hoje com essa deformidade, sendo mais frequente em portadores de deficiência de formação ulnar ou podendo fazer parte de síndromes como de Antley-Bixler e de Hermann. Devidoàrigidezcausadapelaausênciadaarticulaçãodocotovelo,queresultana formação de um osso mais longo com a fusão do úmero no rádio, presume-se que fratura nessa topografia não seja incomum. No entanto, pela raridade dessa patologia, tal lesão apresenta apenas duas descrições prévias na literatura. Relatamos os casos de dois pacientes com fratura do osso único formado pela sinostose entre o úmero e o rádio portadores de falha de formação ulnar do tipo IV de Bayne. Ambos os pacientes foram tratados de forma cirúrgica e evoluíram bem. Salientamos a necessidade do tratamento adequado para não comprometer as atividades da vida de um paciente já adaptado à deformidade, evitando piorar a função de um membro já alterado.

Improving the Accuracy of Corrective Osteotomy for Congenital Radio Ulnar Synostosis using the Axis of Rotation of the Forearm as a Guide

@#Introduction: Despite several techniques for corrective osteotomy in congenital radioulnar synostosis (CRUS) the published literature lacks a guide for radiographic planning and rationale for the site and level of the osteotomy. The primary objective of this study is to report a technique of radiographically controlled corrective osteotomy using the axis of rotation of the forearm in CRUS. Materials and methods: Children with CRUS underwent corrective osteotomy based on radiographic planning; the extent of rotational correction and functional outcomes were assessed at a mean of 27 months after the operation. Results: Seven forearms in six children of an average of 6.25 years were assessed for correction and functional outcomes. The average pre-operative pronation deformity was 71.5°. The average correction achieved was 64°. At follow-up, there were five excellent and two good functional outcomes. All children could perform daily tasks besides eating with hand and personal hygiene. Conclusion: Radiographic determination of the osteotomy sites by the method described is effective, consistent, and reproducible in achieving optimal functional outcomes in congenital radioulnar synostosis.

Síndrome de Klippel-Feil en un lactante / Klippel-Feil syndrome in an infant

Se presenta el caso clínico de un lactante de 11 meses de edad, quien fue remitido a la consulta de Genética Clínica del Centro Provincial de Genética Médica de la provincia de Holguín, por presentar dismorfias faciales asociadas a retardo motor, cuello corto y disminución de movimientos. Se realizó interrogatorio, examen físico exhaustivo y estudios radiológicos de columna cervical, que mostraron la fusión de vértebras cervicales, lo cual permitió diagnosticar el síndrome de Klippel-Feil. Se proyectó habilitación con ejercicios para fortalecer los músculos paravertebrales y se brindó asesoramiento genético a la familia.

The case report of an 11 months infant is presented, who was referred to the Clinical Genetics Service of the Medical Genetics Provincial Center in Holguín province, due to facial dysmorphias associated with motor retardation, short neck and decreasing movements. Interrogation, exhaustive physical exam and radiological studies of cervical column were carried out that showed the fusion of cervical vertebras, which allowed to diagnose the Klippel-Feil syndrome. A qualification with exercises was projected to strengthen the paravertebral muscles and genetic advice to the family was provided.

Research progress of superhydrophilic implants / 中国基层医药

In the past few decades, some studies reported that changing the specific surface properties of titanium implants, such as surface morphology, surface chemistry, surface charge and wettability, improved the bone bonding ability of titanium implants. Based on the existing evidence, this review paper analyzes the methods and characteristics of surface chemical modification of the superhydrophilic implants (Thommen INICELL?) that were listed in China in recent years, and clarifies the process of early osseointegration from the viewpoint of histomorphology, and evaluates its clinical application effects.

Surgical Resection of Intermetatarsal Coalition of the Fourth and Fifth Founded in Long Distance Running / 대한스포츠의학회지

Intermetatarsal coalition (IC) is very rare; although few cases have been reported in foreign orthopedic journals, these have not originated in our country. We report the case of a 20-year-old man who complained of pain in the left forefoot only during long distance running (3 km). On examination, his foot shape, skin appearance, and gait were normal, with no plantar keratosis; however, the radiograph revealed coalition between the fourth and fifth metatarsals. Surgical excision was performed. In the histopathologic study, fibrous coalition was confirmed. This paper reports an uncommon case involving surgical excision of IC in the military service, involving active sport activity.

Treatment of congenital radioulnar synostosis with radial derotational osteotomy and local subcutaneous pedicled fat flap filling in fusion area / 中国修复重建外科杂志

Objective: To investigate the effectiveness of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation for the treatment of congenital radioulnar synostosis. Methods: Between February 2014 and June 2018, 36 patients (41 sides) with congenital radioulnar synostosis were analyzed retrospectively, including 21 males and 15 females, aged 2.5-4.5 years with an average of 3.1 years. The fixed pronation deformity of the forearm ranged from 30° to 90° with an average of 71.6°, and the range of motion of the elbow flexion was 120°-135° with an average of 128.2°. According to the Cleary-Omer classification, there were 8 sides of type Ⅱ, 17 sides of type Ⅲ, and 16 sides of type Ⅳ. All patients were treated by local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation. The range of motion of the elbow, muscle strength, joint stability, and patient discomfort were evaluated by using the Broberg and Morrey elbow scoring system preoperatively and postoperatively. In addition, the ability for daily living of the affected limb was evaluated by using the Failla grading standard. Results: Radial nerve palsy occurred in 3 cases, and nerve function recovered at 2-4 weeks after operation. All the 36 cases were followed up 6-52 months, with an average of 38 months. All osteotomy sites healed, the healing time was 5-12 weeks (mean, 6.3 weeks), and the pedicled fat flap between the radius and ulna survived when the internal fixation was taken. At last follow-up, the flexion range of motion of elbow joint was not decreased, and the pronation and supination range of motion of forearm were improved. The elbow flexion range of motion was 125°-135° with an average of 132.4°. The pronation range of motion of forearm was 15°-45° with an average of 30.1°, and the supination range of motion of forearm was 10°-40° with an average of 22.6°. At last follow-up, the Broberg and Morrey elbow scores increased from the preoperative 85.6±1.0 to 91.8±1.8, showing significant difference ( t=25.593, P=0.000). Moreover, the results were good in 3 sides, fair in 9 sides, and poor in 29 sides according to the Failla grading standard before operation, with an excellent and good rate of 7.3%. At last follow-up, the results were excellent in 6 sides, good in 28 sides, and fair in 7 sides, with an excellent and good rate of 82.9%, showing significant difference when compared with preoperative value ( Z=-5.781, P=0.000). Conclusion: The application of local subcutaneous pedicled fat flap filling and separation of the synostosis area associated with radial shortening osteotomy and plate internal fixation is an effective surgical method for the treatment of congenital radioulnar synostosis. It can restore the partial rotation function of the forearm and improve the quality of life of children.

Tibio-talar coalition - a case report and review of the literature

Background: A tarsal coalition is a bridging of two or more of the bones in the hindfoot. Multiple coalitions aredescribed in the literature. However, the presence of a tibio-talar coalition has not previously been reported.Results : Here, we describe the first reported case of tibio-talar and fibulo-talar coalition in the literature in a 31-year-old male. The patient had a 5-year history of bilateral hindfoot and ankle pain, with an established rightsided talo-calaneal coalition. Investigations and subsequent open chilectomy and debridement surgery confirmeda tibio-talar and fibulo-talar coalition. The patient was discharged at one-year following surgery as he was painfree and returned to work.Conclusions: We report the first case of failure of mesenchymal segmentation leading to tibio-talar fibrouscoalition and fibulo-talar coalition. In this case surgical debridement provided resolution of symptoms. Level ofClinical Evidence: 4

Treatment of congenital proximal radioulnar synostosis using pedicle posterior interosseous perforator adipofascial flaps / 中华整形外科杂志

Objective@#To present the clinical result of a procedure using pedicle posterior interosseous perforator adipofascial flaps for the treatment of congenital proximal radioulnar synostosis (CPRUS).@*Methods@#Eight forearms (from eight patients) with CPRUS were treated by the operation during December 2013 to January 2018 at Beijing Jishuitan Hospital. The average age of the children are seven years old (range: five years old to twelve years old). There were six boys and two girls. Seven forearms were classified as the Cleary type Ⅲ, and one forearm was classified as the Cleary type Ⅱ. Five children were suffered with bilateral CPRUS, and three children were unilateral. The average fixed forearm pronation angle was 43° (range: 0° to 80°). The operating procedure: a dorsal incision from olecranon to the distal 1/3 part of the middle axial of forearm was designed. Then the pedicle posterior interosseous perforator adipofascial flap was harvested. Elevated the anconeus muscle retrogradely, and the location of the osseous synostosis was exposed. Then the radial volar Henry incision just below the elbow joint crease was designed, the insertion part of the biceps brachii was exposed and elevated. The osseous synostosis was exposed and removed with the help of burr at the dorsal side. The cartilage part of the radial head was remolded. A trapeziform osteotomy was made at the site of radial tubercle due to the deformity angle of the radial shaft to reduce the dislocated radial head, then the distal and proximal part of radius was reduced and fixed with plate and screw. The pronator quadratus and the adipofascial flap were pulled to the volar side, and sutured to the deep fascia. The tendon of the biceps brachii was pulled dorsally and reattached to the radial tubercle. Postoperatively, an above-the-elbow splint was applied to keep the elbow in 90° of flexion and the forearm in 80° of supination. Three days later, the other splint was used to keep the forearm in 80° of pronation. Two splints were worn every other day alternatively. At four weeks after the operation, the ROM exercises were initiated both actively and passively, with the splints worn every other night alternatively. The splint was worn for six months.@*Results@#All patients received follow-up, the average duration of follow-up was 27 months (average: 6-48 months). The space of the proximal radioulnar joint could be seen clearly in seven patients, without the sign of recurrence of the synostosis. The synostosis was occurred in one child. Removed the synostosis part and the implant six months after operation, and placed an allograft tendon ball as the interposition tissue simultaneously. The problem was resolved successfully after that. Fingers extension weakness was happened in two patients, and recovered spontaneously and completely in three months. Limitation of elbow extension was occurred in two patients (range: 15° and 20°). The average pronation was 32.5° (range: 10°-65°), and the average supination was 31.9° (range: 10°-70°).@*Conclusions@#Using the perforator adipofascial flap pedicled with posterior interosseous vessels to treat the CPRUS is an easier method compared with classical Kanaya method . It could prevent the recurrence of synostosis effectively, and the treatment result is satisfied. The possibility of injury of the deep branch of radial nerve may be the potential problem.

The clinical application of the location of euryon in nonsyndromic sagittal synostosis / 中华整形外科杂志

Objective@#In clinical, cephalic index is the most common method to evaluate scaphocephaly. However, cephalic index alone is not sufficient to describe the nuances of skull shape. The authors hypothesize that the location of euryon could be a valuable and practical index as the supplement of cephalic index to better describe the skull.@*Methods@#This is a retrospective study. CT scans of 17 scaphocephaly patients and 17 normal controls were included. Eight of 17 scaphocephaly patients have 6 months postoperative CT scan. The preoperative location of euryon of scaphocephaly patients was compared to that of the controls and postoperative. The horizontal location of euryon was defined as the ratio of the distance, from the most prominent point of forehead to euryon, to anteroposterior cranial length. The vertical location of euryon was defined as the ratio of the vertical distance, from the nasion to euryon, to cranial height.@*Results@#Both the horizontal and vertical locations of euryon of preoperative scaphocephaly patients were significantly decreased compared to normals (46.50%±4.02% vs. 50.39%±2.21%, t=3.49, P=0.0014; 35.78%±8.62% vs. 52.6%±8.08%, t=5.86, P<0.001). Both the postoperative horizontal vertical locations of euryon were significantly increased, when compared to preoperative (47.25%±4.23% vs. 44.02%±3.72%, t=2.42, P=0.045; 42.39%±9.06% vs. 35.18%±5.36%, t=2.554, P=0.0379).@*Conclusions@#The location of euryon could be a practical and valuable index to describe the nuances of skull shape.

Type Ⅰ collagen combined titanium dioxide nanotube composite coating modified titanium surface improves osteoblast adhesion and osseointegration / 中国组织工程研究

BACKGROUND: Simple nanotube surface modification of titanium implant has been shown to promote adhesion, proliferation and differentiation of osteoblasts. Collagen coating can promote osteoblast adhesion and osseointegration in vivo. OBJECTⅠVE: To observe the effects of type collagen combined titanium dioxide nanotube composite coating modified titanium surface on osteoblast adhesion in vitro and osseointegration in vivo. METHODS: The titanium dioxide nanotube was fabricated on the pure titanium surface, then type Ⅰ collagen was combined with the nanotube structure to form composite coating. Scanning electron microscope observation was used to characterize the surface topography of the pure titanium, titanium dioxide nanotube and type Ⅰ collagen combined titanium dioxide nanotube surfaces. Contact angle test was employed to evaluate the hydrophilicity of different samples. MC3 T3-E1 murine preosteoblasts were seeded on the three kinds of materials for 4 hours. Cell adhesion morphology was examined by scanning electron microscope. Adherent cell counting was detected under inverted fluorescence microscope. Expression of actin cytoskeleton and vinculin was observed under laser scanning confocal microscope. The gene expression of vinculin and osteoprotegerin mRNA was detected by real-time quantitative PCR. The three kinds of samples were implanted into the tibia of Sprague-Dawley rats (provided by Laboratory Animal Center, Ⅰnstitute of Radiation Medicine, Chinese Academy of Medical Sciences) , and tibia samples were removed after 4 weeks of implantation for biological push-out test and histological observation. RESULTS AND CONCLUSⅠON: (1) Scanning electron microscope: There was mechanical scratch on the pure titanium surface. There was controllable, and uniform vertical arrangement of nanotubular structures with a diameter of approximately 70 nm on the titanium dioxide nanotube surface, and collagen adhered surrounding the nanotubular structures on the type Ⅰ collagen combined titanium dioxide nanotube substrate, and partial tubule orifices were closed. (2) The hydrophicility of type Ⅰ collagen combined titanium dioxide nanotube was significantly larger than those of the other two materials (P < 0.05) . (3) Compared with the pure titanium and titanium dioxide nanotube surfaces, the type Ⅰ collagen combined titanium dioxide nanotube substrate displayed increased adherent cell number, much well-organized cytoskeleton, enhanced immunofluorescence intensity of vinculin protein staining, and increased expression levels of vinculin and osteoprotegerin mRNA levels (all P < 0.05) . (4) Ⅰn vivo test revealed that the maximum push-out force in the type Ⅰ collagen combined titanium dioxide nanotube group was significantly higher than that in the pure titanium and titanium dioxide nanotube groups (P < 0.05) . Hematoxylin-eosin staining results showed that there were few bones, but many fibrous connective tissue surrounding the implant in the pure titanium group; there were more newly-born bones, and less fibrous connective tissue surrounding the implant in the titanium dioxide nanotube group; there were dense newly-born bones, and few thin fibrous connective tissue surrounding the implant in the type Ⅰ collagen combined titanium dioxide nanotube group. (5) These results indicate that type Ⅰ collagen combined titanium dioxide nanotube surface can facilitate osteoblast cell adhesion and promote osseointegration in vivo.

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report

@#Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

A Spectrum Of Vertebral Fusion Defects

Any congenital or acquired abnormality in the vertebral column is of interest for radiologist, orthopedician,forensic pathologist, neurologist and clinical anatomist. Such abnormality in the vertebrae may be eitherasymptomatic or may limit our movements because of the important structures related to them.During the osteology demonstration session for medical undergraduate students, we have found a few abnormalvertebrae of different regions of the spinal column.The clinical implications and embryological significance of these specimens is discussed here

Research progress in the function of monocyte/macrophage-lineage origin cells in the peri-implant osseointegration interface / 中华口腔医学杂志

Although many studies have focused on how material surface modifications can promote stem cell differentiation toward osteogenic osteoblasts, little is known about the reaction between material surface and other cells, including osteoclasts and foreign body giant cells. Dental implant osseointegration results from the functional coupling and equilibrium not only between osteoblasts and osteoclasts but also between bone tissue and immune system. Osteoclasts and foreign body giant cells share the same origin, monocyte/macrophage lineage cells, which have initially got concerns in the field of implant osseointegration with regard to their peri-implant distribution and biological functions. Up-to-date data has shown that cells of monocyte/macrophage lineage origin manifest key roles in the establishment of peri-implant osseointegration and the long-term maintenance of marginal bone level and the prevalence of peri-implantitis. However, preliminary progress has been made in the subtypes, phenotypes vs. genotypes, and functions of monocyte/macrophage-lineage-originated cells on the osseointegration interface, quite a lot of facts still remain unclear, especially the potential and the rapeutic targets which could coordinate the cellular peri-implant microenvironment and the implant osseointegrated interface in the short and long term. This review will focus on the current progress in the function of monocyte/macrophage-lineage origin cells on the peri-implant osseointegration interface.

Effect of traditional Chinese medicine on osseointegration and bone absorption of implants / 中华口腔医学杂志

Implantation of the base bone in the implant after effective and rapid bone binding and prevention and treatment of bone resorption, to ensure the success of planting surgery is of great significance. This article reviews the mechanism of traditional Chinese medicine promoting bone integration and the etiopathological mechanism of bone resorption, and expounds the influence of traditional Chinese medicine on osseointegration and bone resorption.

Experimental study of transforming growth factor-β3 combined with dental pulp stem cells in promoting the implant's osseointegration / 中华口腔医学杂志

Objective@#To investigate the effect of transforming growth factor-β3 (TGF-β3) and dental pulp stem cells (DPSC) in promoting the implant's osteointegration.@*Methods@#Thirty-three New Zealand white rabbits were randomly divided into phosphate buffer saline (PBS) group, DPSC group and TGF-β3 + DPSC group (12 rabbits/group). Two teeth from the rabbits's mandibular incisors or molars were pulled out randomly, then implant were placed in the tooth extraction site immediately. In PBS group, the implant area was filled with Bio-Oss powder 0.30 g mixed by PBS 20 μl only; while the implant area was filled with Bio-oss powder 0.30 g and 1×108/L DPSC 20 μl in DPSC group; in the the TGF-β3+DPSC group the implant area was filled with Bio-Oss powder 0.30 g mixed with 1×108/L DPSC 20 μl and 80 μg/L TGF-β3 20 μl. Eighteen New Zealand rabbits were executed in the 4 weeks and 8 weeks respectively. The treated alveolar bone tissue and implant were collected for plastic section. Alizarin red staining (ARS), immunohistochemical detection (IHC) of bone sialoprotein (BSP), osteocalcin (OC) and type Ⅰ collagen (COL-Ⅰ) were performed after 4 weeks and 8 weeks. Combined bone lamelta width (CBLW) and implant bone contact rate (IBCR), trabecular width (TW) and trabecular area percentage (TA) were observed by histomorphometric measurement.@*Results@#ARS staining: 4 weeks after the operation, the TGF-β3+ DPSC group showed more red calcified nodules than the other two groups; 8 weeks after operation, the red calcified nodule was further increased. 4 weeks after the operation, the expression of BSP, OC and COL-Ⅰ was (0.35± 0.04), (0.36 ± 0.03) and (0.39 ± 0.01) respectively in TGF-β3+ DPSC group, (0.27 ± 0.02), (0.24 ± 0.01) and (0.28±0.03) respectively in DPSC group, and (0.13±0.03), (0.15±0.02) and (0.16±0.02) respectively in PBS group. Eight weeks after operation, the expression of BSP, OC and COL-Ⅰ was (0.51±0.02), (0.49±0.03) and (0.53±0.02) respectively in TGF-β3+DPSC group, (0.35±0.02), (0.37±0.01) and (0.38±0.01) respectively in DPSC group, and (0.21±0.03), (0.19±0.01) and (0.22±0.02) respectively in PBS group. After 4 weeks and 8 weeks, the expression of BSP, OC and COL-Ⅰ in TGF-β3+DPSC group were significantly higher than the other groups (P<0.05), there was no significant difference between DPSC group and PBS group (P>0.05). Eight weeks after operation, the CBLW, IBCR, TW and TA around implant in TGF-β3+ DPSC group were significantly higher than that in the other groups (P<0.05), there was no significant difference between DPSC group and PBS group (P>0.05).@*Conclusions@#The DPSC has the potential osteogenic differentiation ability; TGF-β3 can accelerate the osteogenic differentiation of DPSC to some extent; TGF-β3 combined with DPSC can effectively promote the implant's osseointegration.

Osteotomía desrotadora para el tratamiento de la sinostosis congénita radiocubital proximal / Detracting osteotomy for the treatment of proximal radiocubital congenital synostosis

Generalidades: la sinostosis congénita radiocubital proximal se caracteriza por un déficit de segmentación entre el radio y el cúbito que forma un puente óseo o fibroso que limita la supinación y pronación del antebrazo. Objetivo: describir de la técnica quirúrgica de osteotomía desrotadora para el tratamiento de sinostosis congénita radiocubital proximal y los resultados obtenidos en los pacientes. Materiales y métodos: entre febrero de 2013 y junio de 2015 se realizó osteotomía desrotadora para el tratamiento de sinostosis congénita radiocubital proximal en el Hospital Pediátrico Docente "Baca Ortiz" a 7 niños con un total de 12 antebrazos; 5 bilaterales y 2 unilaterales derechos; con un promedio de edad de 5 años 3 meses. El promedio de seguimiento fue de 1 año 4 meses. Los resultados incluyen el grado de fijación de pronación de la deformidad, el rango de movimiento pre y postoperatorio de supinación y pronación. Resultados: se obtuvo 9 antebrazos (75%) con resultados excelentes, 2 (16.7%) con resultados buenos y 1 (8.3%) con resultado regular. Una ganancia de rango de movimiento de supinación en promedio de 50.8º y una reducción de rango de movimiento de pronación en promedio de 85.8º. Conclusiones: la osteotomía desrotadora es una técnica quirúrgica efectiva para tratar la sinostosis congénita radiocubital proximal. (AU)

Background: The Congenital Proximal Radioulnar Sinostosis is characterized by a lack of segmentation between the radio and ulna, which constitute a osseous bridge or fibrous union that borders the supination and pronation of the forearm. Objective: To describe the surgical technique of derotational osteotomy for the treatment of Congenital Proximal Radioulnar Sinostosis, as well as evaluate the observed results in patients. Materials and Methodology: from February 2013 to June 2015, an derotational osteotomy for the treatment of Congenital Proximal Radioulnar Sinostosis was applied on seven children, for a total of twelve forearms; five bilateral, and two right unilateral; with an age average of 5 years and 3 months. The average follow-up time was 1 year and four months. The results include the degree of fixation in pronation of the deformity, the range of pre and post surgical movement of supination and pronation. Results: We obtained nine foreams (75%) with excellent results, two (16.7%) with good results and one (8.3%) with regular results. A gain in the range of movement of supination, on average, of 50,8º, and a reduction in the range of movement of pronation, on average, of 85.8º. Conclusions: The derotational osteotomy is a surgical technique effective for the treatment of Congenital Proximal Radioulnar Sinostosis.(AU)

Ataque cerebrovascular recurrente secundario a síndrome del opérculo torácico arterial causado por sinostosis de la primera y la segunda costillas torácicas: reporte de caso / Recurrent Stroke Secondary to Arterial Thoracic Outlet Syndrome Caused by First and Second Ribs Synostosis: Case Report

El ataque cerebrovascular recurrente (ACV) es una complicación rara del síndrome del opérculo torácico arterial. Presentamos un paciente de 24 años con isquemia del miembro superior derecho y ACV recurrente en territorio vertebro basilar secundario a estenosis y aneurisma de la arteria subclavia, causado por sinostosis de la primera y segunda costillas torácicas. El paciente fue tratado quirúrgicamente con costocondrectomía y escalenectomía bilateral, resección de aneurisma de la arteria subclavia derecha y anastomosis primaria. Se analizó el caso y se revisó la literatura pertinente sobre ACV y síndrome de opérculo torácico arterial.

Stroke is a rare complication of arterial thoracic outlet syndrome. We present a 24-year old man with right arm ischemia and recurrent vertebrobasilar stroke caused by synostosis of the first and second thoracic ribs. The patien was treated with supraclavicular resection of both first ribs and bilateral scalenectomy, aneurysmal resection and primary anastomosis of the right subclavian artery. We analize this case and review the pertinent literature on stroke and arterial thoracic outlet syndrome.

Craneosinostosis: Revisión de literatura / Craniosynostosis: Literature review

Las craneosinostosis consisten en el cierre prematuro parcial o total de una o más suturas craneales, con una incidencia de 1 de cada 1000 a 3000 nacidos vivos, con mayor prevalencia en varones. Dentro del contexto de las craneosinostosis primaria, la escafocefalia o craneosinostosis sagital es la forma más frecuente y conocida. Al presentarse en un período de vida donde el crecimiento cráneo cerebral es muy importante, ocasiona en los niños una deformidad craneal característica que debe ser corregida, ya que en caso contrario y al ser progresiva, la afectación estética puede ser muy indeseable; las alteraciones funcionales que se pueden presentar van desde aumento de la presión intracraneana, hasta convulsiones, entre otras. Se realizó una búsqueda en bases de datos como PUDMED, RIMA, MEDLINE, MEDSCAPE de revisiones de temas, guías de manejo, artículos y análisis estadísticos, en idioma inglés, donde se encontraron 1.469 referencias. Después de una primera mirada de los artículos a través de sus resúmenes comprendidos en el periodo de tiempo año 2000 a 2014, finalmente se seleccionaron 50 artículos en texto completo abarcando el tema en su totalidad que cumplían los requisitos de búsqueda.

The craniosynostosis consist of full or partial premature closure of one or more cranial sutures, with an incidence of 1 in 1000 3000 live births, with higher prevalence in males. Within the context of primary craniosynostosis, sagittal craniosynostosis scaphocephaly or is the most common and known form. To occur over a period of life where growth cranium is very important causes in children a characteristic skull deformity should be corrected, since otherwise and being progressive, aesthetic involvement can be very undesirable; functional alterations that may occur include increased intracranial pressure, seizures and others. A search was conducted in databases such as PUBMED, RIMA, MEDLINE, Medscape reviews issues, management guides, articles and statistical analysis, in english, where they found 1,469 references. After a first look at the articles through their summaries included in the period 2000 to 2014, finally 50 articles were selected in full text covering the subject fully meeting the conditions search.

Unilateral Talonavicular Coalition: A Case Report / 대한족부족관절학회지

Tarsal coalition is an abnormal union between two or more bones of the hind- and mid-feet, which can occur at various rates from cartilaginous to osseous union. Talonavicular coalition is reported less frequently than calcaneonavicular or talocalcaneal coalition and has been associated with various abnormalities, including symphalangism, clinodactyly, ray anomaly, clubfoot, other tarsal coalitions, and a ball-and-socket ankle joint. Patients with talonavicular coalitions are usually asymptomatic and rarely require surgical treatment. We review the literature and report on a case of 59-year-old male patient with talonavicular coalition.

Radiological Assessment of the Effect of Congenital C3-4 Synostosis on Adjacent Segments

STUDY DESIGN: Retrospective case series. PURPOSE: To assess the effect of non-kyphotic aligned congenital C3-4 synostosis on the adjacent segment in 10 patients. OVERVIEW OF LITERATURE: In the cervical spine, fusion disease at the adjacent motion segments may be a risk factor for potential neurological compromise and death. METHODS: Radiograms of 10 patients 13 to 69 years of age presenting with neck/shoulder discomfort or pain with or without trauma history were examined. C3-4 synostosis was found incidentally in all patients on routine examination radiographs of cervical spine. RESULTS: Adjacent segment disease (ASD) was not found in the three patients younger than 39 years of age. Five of the 10 (50%) patients, including a 67-year-old man, did not develop spondylosis in any of the cervical mobile segments. Spondylosis was observed only in the caudal 1-2 mobile segments in the remaining five patients. The youngest was a 40-year-old male who had spondylosis in the two caudal mobile segments (C4-5 and C5-6). Spondylosis was limited to the two close caudal mobile segments and was not in the cranial segments. Flaring of the lower part of synostotic vertebra associated with advanced narrowed degenerate disc was evident in five patients. CONCLUSIONS: Mobile segment spondylosis in the individuals with congenital monosegment C3-4 synostosis over age of 40 years may be a natural manifestation of aging and is not solely an adjacent segment disease directly and fully related with congenital C3-4 synostosis.