ABSTRACT
Osteogenesis Imperfecta is an inherited disease characterized by easily-broken bones, which manifests as multiple fractures with minimal trauma, joint laxity, sclerosis, blue sclera, and several other manifestations. Protrusio acetabuli is defined as the displacement of the femoral head so that it lies medial to the ischioilial line. In a skeletally mature patient with both Marfan syndrome and PA, an eventual hip arthroplasty is the only method available for correction of the deformity. However, in patients with Osteogenesis Imperfecta and PA, THA remains a controversial treatment. A 14-year-old male patient diagnosed with Osteogenesis Imperfecta Type 1A presented to the orthopedic surgery clinic complaining of groin pain of 1-year duration radiating to the thigh and knee. The patient was found to have radiologic signs of protrusion acetabuli. The patient was started with bisphosphonate and after medical failure, underwent a Total Hip Arthroplasty (THA). In post-operative follow-ups, the patient had relief of pain and was able to walk more comfortably and without a lump. The previously operated hip was examined and showed no signs of infection, dislocation, or fracture. Radiographic studies show no evidence of prosthesis failure or loosening with valgus position of the femoral stem and neutral acetabular angle. Ten years after the primary arthroplasty, the previously operated hip had maintained its stability and had no related complications. Despite the controversy surrounding the treatment of younger patients with hip failure, using total hip arthroplasty, this patient exhibited excellent results, with vast improvement in their symptoms and stability.
ABSTRACT
PURPOSE: To propose a novel, accurate, and easy to perform test replacing the manual muscle testing. Our target is to develop a valuable tool for identification of patients with neurological motor impairment precisely, rapidly, and easily. METHODS: We have randomly selected patients presenting to the clinic complaining of back pain with or without lower limb symptoms. These patients were asked to walk on their heels and on their toes. Being unable to walk on heels and/or toes, the patient is considered to have positive test result (abnormal finding). After that, a full and thorough neurological examination was performed on every patient by an orthopedic resident doctor. We looked specifically to the correlation between the ability to do toe-heel walking with the results of the detailed neurological examination. RESULTS: Toe-heel walking test was able to detect all patients with weakness in their lower limb musculature. The results from the current investigation indicate a very high Pearson correlation of 0.95 ( p = 0.001) between the toe-heel test and manual muscle testing. CONCLUSION: Toe-heel walking test is superior to detailed neurological examination in identification of patients with weakness, sphincter problem, and/or positive straight leg raising test. This test is both simple and rapidly performed test, which can be easily done by any health-care provider. Owing to its ease, this test is not restricted to medical doctors, but it could be accurately performed by any health-care provider such as nurses and physiotherapists. This will enable us to decrease the referral to the specialty clinic and to decrease the overall cost.
