Cobertura de lesões em pé e terço inferior da perna com retalho fasciocutâneo reverso da panturrilha (Carriquiry) / Coverage of the lower third of the limb and foot injuries using reverse sural fasciocutaneous flap described by Carriquiry

Introdução: Lesões no terço distal dos membros inferiores, com exposição de ossos, articulações, tendões e vasos sanguíneos, não são passíveis do uso de enxertos de pele. Isto ocorre porque o leito vascular é exíguo e pela pobre granulação das feridas, podendo apenas ser corrigidas com retalhos musculares, miocutâneos, fasciocutâneos ou transferência microcirúrgica. Métodos: O retalho em seu limite inferior é demarcado a partir de 5 cm acima dos maléolos. Superiormente, é marcado num comprimento suficiente para cobertura total da lesão. Realizada incisão em demarcação prévia, e elevados pele e tecido subcutâneo juntamente com a fáscia muscular. O nervo sural é preservado em seu leito original. A elevação do retalho se dá até o ponto inferior marcado (o pedículo). Neste ponto, o retalho é transposto numa angulação suficiente para alcançar a lesão. Resultados: Oito casos foram operados utilizando o retalho descrito. Todos apresentavam exposição de ossos e tendões em região distal da perna, dorso do pé ou ambos, nos quais foram utilizados o retalho fasciocutâneo reverso da perna com a técnica proposta por Carriquiry. Os casos apresentaram resultados estético e funcional satisfatórios. Conclusão: O retalho utilizado se presta à correção de lesões do terço inferior da perna e do pé. É relativamente fácil de ser confeccionado, com bom suprimento vascular, e não há perda funcional do leito doador.

Introduction: Skin grafts are not effective to cover lesions in the distal third of the lower limbs that expose the bones, joints, tendons, and blood vessels due to a limited vascular bed and poor granulation of the wounds. These lesions can only be corrected with microsurgical transfer or muscle, myocutaneous, or fasciocutaneous flaps. Methods: The lower border of the flap was marked 5 cm above the malleolus. The upper border was marked after providing sufficient length for complete coverage of the lesion. The incision was performed at the marked upper border, and the skin and subcutaneous tissue were elevated together with muscle fascia. The sural nerve was preserved in its original bed. The flap was lifted to the marked lower border (the pedicle). At this point, the flap was transposed at a sufficient angle to cover the lesion. Results: Eight cases of surgery were conducted using the flap described above. All cases had exposed bones and tendons in the distal region of the limb, back of the foot, or both, in which the reverse sural fasciocutaneous flap with the technique proposed by Carriquiry was used. The cases showed satisfactory esthetic and functional results. Conclusion: The used flap can correct lesions of the lower third of the limbs and foot. It is relatively easy to make, with good vascular supply, and there is no functional loss of the donor area.

Anatomía imagenológica de los huesos accesorios y sesamoideos inconstantes del miembro inferior: ensayo iconográfico / Imaging anatomy of the accessory and inconstant sesamoid bones of the lower limb: an iconographic essay

Se realiza un estudio sobre la anatomía e imagenología de los huesos sesamoideos inconstantes y de los huesos accesorios del miembro inferior. Para ello, se presenta una selección de estudios imagenológicos de pacientes que presentan este tipo de huesos, recolectados durante los últimos tres años.

Estudo anatômico, ultrassonográfico e tomográfico do aparato podotroclear de equinos adultos / Anatomic, tomographic and sonographic study of podotrochlear apparatus of adult horses

A síndrome do navicular é uma condição que envolve o aparato podotroclear e representa uma das causas mais comuns de claudicação dos membros torácicos de equinos. Portanto, o estudo complementar da região reveste-se de grande interesse quando se refere ao diagnóstico e tratamento das claudicações dos equinos. O objetivo deste estudo foi demonstrar as diferenças dos achados imagenológicos entre a ultrassonografia e a tomografia computadorizada na avaliação das estruturas palmares do aparato podotroclear de equinos adultos e hígidos, bem como a descrição das estruturas observadas nas imagens obtidas com essas técnicas. Para isso, foram realizadas imagens de quatro peças anatômicas, as quais foram posteriormente seccionadas e utilizadas para a descrição anatômica. A utilização de peças anatômicas auxilia no conhecimento da anatomia normal, o que leva à melhor interpretação das imagens e aumenta a especificidade diagnóstica na detecção das alterações que as doenças acarretam. A ultrassonografia fornece informações relevantes quanto às estruturas estudadas, e sua associação com a tomografia computadorizada aumentou a acurácia da investigação. Apesar de o uso da tomografia computadorizada ser mais indicada para tecido ósseo, ela fornece informações importantes, podendo ser usada como uma ferramenta útil quando não se tem disponível a ressonância magnética em razão do custo ou da disponibilidade.(AU)

The navicular syndrome is a condition involving the podotrochlear apparatus and represents one of the most common causes of forelimb lameness in horses. Therefore, further study of this region is of interest when it comes to diagnosis and treatment of lameness in horses. The aim of this study was to demonstrate the differences between the imaging findings of ultrasonography and computed tomography in the evaluation of the palmar structures of the podotrochlear apparatus of healthy adult horses and description of the structures observed in images obtained with these techniques. For this, four images of four anatomical parts were performed, and subsequently sectioned and used for the anatomical description. The use of anatomical parts helps in the understanding of normal anatomy leading to a better interpretation of the images and increasing the specificity of the diagnostic for detecting changes that cause diseases. Ultrasonography provides relevant information about these structures to be studied and the association with computed tomography (CT) increased the accuracy of the investigation. Despite the use of CT being more suitable for bone tissue it provides important information and can be used as a useful tool when there is no available MRI.(AU)

El signo de la seta en la coalición talonavicular / Mushroom sign in the talonavicular coalition

Abstract: The talonavicular coalition is a rare congenital anomaly of the foot, often associated with other malformations. Unlike other coalitions, most patients are asymptomatic and do not require surgery. The authors describe two cases of patients with talonavicular coalition, one bilateral and the other unilateral associated with other malformations. The sign of the mushroom is presented as a practical way to diagnose talonavicular coalition on a standing anteroposterior radiograph, in which the contours of the bone fusion mimic the shape of a mushroom. This sign will help radiologists in the proper diagnosis of this rare coalition.

Resumen: La coalición talonavicular es una anomalía congénita poco frecuente del pie, a menudo asociada a otras malformaciones. A diferencia de otras coaliciones, la mayoría de los pacientes son asintomáticos, y no requieren cirugía. Los autores describen 2 casos de pacientes con coalición talonavicular, uno bilateral y el otro unilateral, asociados a otras malformaciones. Presentamos el signo de la seta como una práctica manera de diagnosticar la coalición talonavicular en proyección anteroposterior del pie, en el cual los contornos de la fusión ósea remedan la forma de un hongo. Este signo será de ayuda a los radiólogos para el adecuado diagnóstico de esta rara coalición.

Bizarre Parosteal Osteochondromatous Proliferation (Nora's lesion) of the Big Toe. (A Report of Two Cases and Review) / 대한족부족관절학회지

Bizarre parosteal osteochondromatous proliferation (BPOP) is an rare benign tumor which involve mostly tubular bones of feet and hand. BPOP has clinical, radiographic, and histologic similarities with osteochondroma.Radiologically, BPOP has not central continuity with underlying osseous medulla. Histologically, the lesion has marked proliferative activity, and enlarged, bizzare, and binucleated chondrocytes.Despite the high risk of recurrence, treatment of choice is surgical resection. This report presents two cases of BPOP of the big toe with reviews of clinical, radiographic, and histological characteristics.

First Korean Family with a Mutation in TPM2 Associated with Sheldon-Hall Syndrome

Sheldon-Hall syndrome (SHS) is a rare autosomal dominant, inherited arthrogryposis syndrome characterized by multiple congenital contractures of the distal limbs. To date, four genes that encode the skeletal muscle fiber complex have been confirmed as the causative genes. Mutations in MYH3 have been identified most frequently and few cases of SHS caused by TPM2 mutations have been reported worldwide. This report describes, for the first time, a Korean family with two generations of SHS resulting from a rare TPM2 mutation, p.R133W. The affected mother and daughter manifested typical facial features of SHS including a triangular face with downslanting palpebral fissures, small mouth, high arched palate, and prominent nasolabial folds, and showed camptodactyly of fingers and deformities of feet with congenital vertical tali. Generalized myopathy with relative sparing of the slow-twitch muscle fibers was also revealed by electromyography in the affected mother.

Notre experience sur la traction des fractures des os des membres inferieurs chez l'enfant a partir de la botte platree

Les auteurs rapportent leur experience de la traction des fractures des membres inferieurs chez l'enfant en se servant de la botte platree.Methodes 296 tractions ont ete appliquees a l'hopital de Ndjili/ ISTM entre l'an 2000 et 2010 Resultats avec 12 d'escarres par compression. Ce resultat parait meilleur en le comparant a celui obtenu par traction au sparadrap (34;7 des phlyctenes); en l'absence des bandes adhesives appropriees. Les escarres apres usage de la couche d'ouate suffisamment epaisse au talon et au dos du pied n'ont pas ete rapportees.Conclusion Les auteurs ont resolu la difficulte materielle vecue devant les fractures des enfants dans les milieux a ressources limitees

Evaluation of the surgical treatment of Lisfranc injuries / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical results of surgical treatment for Lisfranc fracture-dislocation.</p><p><b>METHODS</b>From January 2003 to September 2009, 57 patients with Lisfranc injuries were treated by surgical operation included 41 males and 16 females with an average age of 33.8 years old ranging from 20 to 64 years. According to Myerson's classification, there were 31 cases of middle column injuries, 15 cases of medial-middle column injuries and 11 cases of three-column injuries. Among them, 25 patients accepted the emergency operation (<24 hours) and 32 patients were treated in average 7 days (3 to 11 days) after injury.</p><p><b>RESULTS</b>All the wounds were healed primarily with a mean operative time of 50 min (30 to 70 min). All patients were followed up for 4 to 70 months (averaged 35 months). The total AOFAS scores (American Orthopaedic Foot and Ankle Society) was in averaged of(84.73 +/- 14.26). All the patients returned to normal daily life after a mean time of 5.1 months (3 to 12 months). The average AOFAS scores of 52 anatomical reduction cases was (87.63 +/- 13.71), 5 non-anatomical reduction cases was (74.31 +/- 21.96), 26 multiple column trauma cases was (76.58 +/- 11.51). Complications of osteoarthritis occurred in 8 cases, confirming it was the main complication of these injuries.</p><p><b>CONCLUSION</b>Lisfranc injuries can be surgically treated well. Reduction of the middle column is the key to reestablishment the stability of the tarsometatarsal joint complex. The quality of the reduction correlated with treatment outcome.</p>

Anatomic and radiographic study of Egyptian calcaneal angles in comparison to other populations

This study was performed to determine the mean Egyptian calcaneal angles: Bohler's angle [BA] and Gissane's angle [GA] in comparison to other populations. Lateral plain radiographs of 267 normal Egyptians' feet and ankles, of 184 females and 83 males, with an age range of 17-69 years, were studied retrospectively at Erfan hospital Jeddah KSA, between August 2005 to July 2006. Six reformatted CT scans and Eight MRI of the ankle were studied measuring the BA and GA to determine the fallacies in radiographic readings. In addition, 30 adult dry calcaneal bones [17 right and 13 left], 7 of which were of known sex [5 males and 2 females] were collected from the Anatomy Department, Faculty of Medicine, Ain Shams University. The values of BA and GA were estimated on the dry bones and their lateral plain radiographs. The range, mean and standard deviation of each angle were calculated. Using the student t-test and One-Way Analysis of Variance, the presence of statistical differences between age, gender and side of the body were determined for both angles. Moreover, the results of the present study were compared with those of other populations to determine any racial differences. The mean of BA in the Egyptian population was 31.5° with a range of 15-48° in males and 30.5° with a range of 19-42° in females. The mean of GA was 117° with a range of 100-134° in males and 125° with a range of 101-149° in females. Bohler's angle and GA were not significantly related to gender or side of the body. However, there were statistical significant differences between different age groups. Moreover, the range of both angles was greater than that reported in other population-samples. No significant different values were obtained between dry bones and those of plain radiographs. This study showed the statistical dissimilarity between the different populations as regards to BA and GA and reinforced the need to establish the normal ranges of BA and GA in a given population. These angles were shown to be an accepted method for quantifying fracture displacement and predicting the prognosis of calcaneal fractures. By using simple radiographic measurements, the data of the present study might lead to better diagnosis and treatment

[Callus distraction by a distractor device for lengthening of short bones of hand and foot]

This study is performed to evaluate the results of lengthening of the fingers or congenitally short phalanxes, metacarpal and metatarsal bones by callus distraction technique. In this study we used a newly designed callus distraction device which is simple, reliable and easy to use. This study included 46 patients, 20 females and 26 males with short bones of hands or feet. The mean age of the patients was 17 years [age range 4-23 years]. 67% of our patients had traumatic amputation of fingers or toes. The mean duration of follow up of the patients was 56 months. The mean length of metacarpal, phalangeal and metatarsal bones before surgery was 31 mm [range 30-35 mm]. The mean bone length increase after surgery was 16 mm [range 15 to 27 mm] i.e. more than 50% of the bone length. Mean healing index ratio was 5.53 days/millimeter. No bone graft was required after bone lengthening. Complications were, pin tract infection in 2.5%, hypertrophic scar on the dorsum of foot in 8.5%, neurovascular complications in 1%, reversible stiffness in joints in 9.5% and bone pain in 12% of the patients. Callus distraction is an effective and reliable method for lengthening of short phalangeal, metacarpal and metatarsal bones. It also preserves the periosteal bone tissue. Our distractor device is reliable and highly effective for callotesis

A prospective longitudinal study of normal reference ranges for the length of fetal limb bones by ultrasound examination / 대한산부인과학회지

OBJECTIVE: To establish the reference ranges for the length of fetal limb bones (femur, tibia, fibula, humerus, ulna, radius, foot) at 12 to 38 weeks' gestation. METHODS: The candidates of this prospective longitudinal study were 43 consecutive women with uncomplicated singleton gestations who initially had antenatal care from the first trimester of pregnancy and follow-up regularly. We performed serial measurements of each limb bone and foot bone length by ultrasound examination every 4 weeks until 28 weeks, and then by 2 weeks until 36 weeks, and weekly thereafter. RESULTS: A total of 2,633 and 321 of fetal limb and foot bone lengths were measured. The reference ranges for the length of limb bones and foot length were presented as mean, 95% confidence interval of the means and in percentile. CONCLUSIONS: Our study results are represented as percentile tables for each of the limb bone length. These results can be provided as standardized data of the fetal limb bone length to distinguish from skeletal dysplasia and may well be suggested as the reference guideline for normal fetal limb bone length in Korea.

Septic monoarthritis and osteomyelitis in an elderly man following Klebsiella pneumoniae genitourinary infection: case report

<p><b>INTRODUCTION</b>Klebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint.</p><p><b>CLINICAL PICTURE</b>The patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of the ankle. On admission, he was in septic shock. Investigations suggested an infective cause, as evidenced by raised total white cell count and pyuria. K. pneumoniae was cultured from both urine and ankle synovial fluid. Imaging confirmed multiple liver and prostatic abscesses, as well as osteomyelitis of the foot bones adjacent to the ankle.</p><p><b>TREATMENT</b>Treatment in this case included surgical drainage of the affected joint and surrounding soft tissue structures, in addition to a 6-week course of systemic antibiotics.</p><p><b>OUTCOME</b>The patient had good clinical response following treatment. In addition, we noted a normalisation of his laboratory parameters and resolution of the intraabdominal and pelvic abscesses.</p><p><b>CONCLUSION</b>This case emphasises the importance of timely and accurate diagnosis followed by appropriate treatment in disseminated K. pneumoniae infection to prevent significant morbidity and mortality.</p>

Identification of sex depending on radiological examination of foot and patella

The present work was carried out to investigate the possibility of the estimation of sex from some radiological measurements among a known cross section of Egyptian population. Lateral and anteroposterior radiographs of the right foot and knee were made on 160 living unfractured and non pathological individuals comprising 80 males and 80 females aged 25-65 years. Two measurements on right patella [maximum height and maximum width] and two measurements of metatarsal bones [length and mid shaft diameter] were used to determine sex by univariate and multivariate discriminant analysis. The study revealed significant sex differences, based on these measurements taken on patella or metatarsal bones. One function associating two parameters [length and mid shaft] of the third metatarsal bone obtained the highest value of correct sex determination with a rate of 100% accuracy. The study suggested that the radiographs of the knee and foot are convenient, rapid, cheap and noninvasive means for estimating sex

99mTc-HDP Pinhole SPECT Findings of Foot Reflex Sympathetic Dystrophy: Radiographic and MRI Correlation and a Speculation about Subperiosteal Bone Resorption

Reflex sympathetic dystrophy (RSD) is a common rheumatic disorder manifesting painful swelling, discoloration, stiffening and atrophy of the skin. Radiographic alterations include small, spotty subperiosteal bone resorption (SBR) and diffuse porosis, and MR imaging shows bone and soft-tissue edema. The purposes of current investigation were to assess 99mTc HDP pinhole SPECT (pSPECT) findings of RSD, to correlate them with those of radiography and MRI and to speculate about causative mechanism of SBR which characterizes RSD. pSPECT was performed in five patients with RSD of the foot. pSPECT showed small, discrete, spotty hot areas in the subperiosteal zones of ankle bones in all five patients. Diffusely increased tracer uptake was seen in the retrocalcaneal surface where the calcaneal tendon inserts in two patients with atrophic RSD. pSPECT and radiographic correlation showed spotty hot areas, that reflect focally activated bone turnover, to closely match with SBR. Further correlation with MRI showed both spotty hot areas and SBR to coincide in location with the insertions of ligaments and tendons, onto which pulling strain is constantly exerted. In contrast, the disuse osteoporosis in unstrained bones did not show any more significantly increased tracer uptake than normal cancellous bones.

Fractura de la base del quinto metatarsiano: Informe de un caso y revisión de la literatura / Fracture of the fifth metatarsal base: Case presentation and review

RESUMEN. Informamos de un caso de fractura de la base del quinto metatarsiano bilateral, cada una a diferebnte tiempo en un paciente de 19 años de edad. Se presentó por primera vez el 17 de febrero del 2000, quien al estar jugando fútbol sufrió unalesión por inversión forzada del pie izquierdo, luego de lo cual presentó dolor en cara externa del pie con poco edema. Las radiografías mostraron una fractura diefisaria proximal del quinto metatarsiano levementedesplazafda. El 17 de julio del 2001 se presenta con historia de estar nuevamente jugando fútbol sufriendo nueva lesión en inversión forzada, esta vez del pie derecho en donde por radiología se demuestra la presencia de una fractura de base del quinto metatarsiano.

Evolución del pie / Foot evolution

Se realiza un análisis de la evolución del pie humano, desde los primates al hombre moderno, destacando los cambios que se produjeron en el pie para alcanzar la bipedestación. En función de entender cómo se desarrolló la estructura del pie humano se analizó su evolución en nuestro orden biológico; desde el pleisiádapis hace unos 60-65 millones de años, pasando por los distintos primates del Eocénico, Oligocénico, Miocénico, etc. hasta el hombre moderno, arribando a las siguientes conclusiones: A) La bipedestación, la marcha erguida, fue un hecho esencial en el proceso evolutivo desde los primeros primates al hombre moderno. B) El por qué de la bipedestación sigue siendo materia de discusión. C) De los cambios que se produjeron en el pie, me parecen los más importantes: el paralelismo del primer rayo con los otros metatarsianos; formación de los arcos del pie; aumento de la rigidez del ligamento calcáneoescafoideo; inserción del tendón tibial posterior en el escafoides, para el mantenimiento del arco longitudinal; rigidez en las estructuras del pie y alineamiento en los huesos del retropie (calcáneo y astrágalo). D) Creo que algunas patologías que se podrían explicar por la persistencia de caracteres ancestrales, como algunos casos de hallux-valgus y pie plano.

Closed treatment of intra-articular calcaneal fractures with axial pin fixation

Intra-articular fractures of the calcaneus account for approximately 75% of all calcaneal fractures and have been associated with poor functional outcome especially if the posterior subtalar joint is severely disrupted. In the last decade, open reduction and internal fixation of intra-articular calcaneal fractures increased, however, the high rate of skin complications discouraged many surgeons. This paper discussed the results of twenty- four intra-articular calcaneal fractures of the tongue type treated with closed reduction and axial pin fixation. The clinical and radiological results were 79.2%, 83.3% satisfactory results, respectively, after a minimum follow up period of one year