Intraoperatively proven anomalous Struthers' ligament diagnosed by MRI.

A case of median nerve entrapment at the elbow between the supracondylar process and an anomalous insertion of Struthers' ligament is presented. The diagnosis of anomalous insertion of the ligament was made by MRI and confirmed at operation. Struthers' ligament originated as usual from the supracondylar process but did not reach the medial epicondyle of the humerus, inserting instead in the brachial fascia above the epicondyle. The incomplete Struthers' ligament functioned, however, as a complete ligament. It produced symptoms identical to supracondylar process syndrome. Excision of the supracondylar process of the humerus and Struthers' ligament relieved symptoms in this athlete.

Osteogenesis imperfecta at the beginning of bone and joint decade.

Osteogenesis imperfecta (OI), or brittle bone disease, is a heritable disorder characterized by increased bone fragility. Four different types of the disease are commonly distinguished, ranging from a mild condition (type I) to a lethal one (type II). Types III and IV are the severe forms surviving the neonatal period. In most cases, there is a reduction in the production of normal type I collagen or the synthesis of abnormal collagen as a result of mutations in the type I collagen genes. These classic forms of OI are described in this review. There are instances, however, where alterations in bone matrix components, other than type I collagen, are the basic abnormalities of the OI. Recently, three such discrete types have been identified by histomorphometric evaluation (types V and VI) and linkage analysis (Rhizomelic OI). They provide evidence for the as yet poorly understood complexity of the phenotype-genotype correlation in OI. We also discuss bisphosphonates treatment as well as fracture management and surgical correction of deformities observed in the patients with OI. However, ultimately, strengthening bone in OI will involve steps to correct the underlying genetic mutations that are responsible for this disorder. Thus, we also describe different genetic therapeutic approaches that have been tested either on OI cells or on available OI murine models.

[Overuse injury syndromes in children and adolescents]. / Sindromi prenaprezanja u djece i adolescenata.

More and more children participate in sports competitions. The main difference between children and adults is that the former still grow and develop. An immature musculoskeletal system is less able to cope with repetitive biomechanical stress. Sites of overuse injury are the sites of rapid growth: epiphysis, apophysis, and growth plates. Overuse injuries in children most commonly affect the cartilage where it meets with the tendons (nonarticular chondrosis), cartilage and bone at the joints surfaces (primary and secondary osteochondrosis), or the bone and its physis (stress fractures). The most characteristic overuse injuries in children are physeal stress fracture and osteochondrosis. The basic diagnostic and treatment principles in children greatly correspond to those in adults. The prevention of overuse injuries in children is very important. To minimise the injuries, children should be encouraged to limit the length of exercise, use high-quality equipment properly, cross train, and participate in conditioning programs to develop strength and flexibility.

[The Klippel-Trenaunay syndrome]. / Klippel-Trenaunayev sindrom.

The article presents the Klippel-Trenaunay syndrome. The diagnosis was set upon birth based on typical skin angiomatous nevi and hypertrophy of soft tissue and bones. Later on, the patient also developed the third element of the syndrome, i.e. varicose veins. The patient has a rare form of the disease, with hypertrophy of soft tissue in the left forearm and soft tissue and bones of his right leg. The static type macrodactylia is present on both hands and feet. The paper gives clinical description of this rare, nonhereditary disease. The need of continuous multidisciplinary monitoring of such patients is emphasized, since this syndrome should be distinguished from Parkes Weber syndrome which has essentially different prognosis.

Chronic fracture-separation of the radial head in a child.

A rare case of a complete fracture-separation of the proximal radial epiphysis is described in a pediatric patient. A further complicating factor is the delay in diagnosis that may worsen prognosis. An emphasis on early detection by physical examination and imaging studies, as well as consideration of treatment options, are presented.

[The femoral hypoplasia syndrome and unusual facies in an infant of a diabetic mother]. / Sindrom hipoplasticnih femura i neobicnog lica u djeteta majke dijabeticarke.

One-month-old female infant of diabetic mother with the femoral hypoplasia--unusual facies syndrome is presented. At birth the characteristic facial pattern of long philtrum with thin upper lip, micrognathia and cleft palate was present. Both legs showed extreme shortening of the upper segments. X-rays showed numerous skeletal abberations including radioulnar synostosis of the right elbow, dysplastic sacrum and hypoplasia of the femurs, the right one more severe. Radiological findings also revealed abnormal left kidney's collecting system and absence of the right kidney. Possible contributing factors to the pathogenetic mechanism underlying the skeletal defects in infants of diabetic mothers are considered.

Frequency of idiopathic aseptic necrosis in medically treated alcoholics.

The occurrence of idopathic aseptic necrosis of bone in multiple sites has been studied in persons who have had medical treatment for excessive consumption of alcohol. The incidence was 5.3% in 1157 such persons and there were 92 different sites in 62 patients. There were 82 lesions affecting the femoral head, 46 in the left hip and 36 in the right. In 10, it was present in the head of the humerus. Multiple foci were found in 6.1% of patients with the disease. In 2 men and 2 women both femoral heads and both humeral heads were affected. In 2 men the necrosis was present in both humeral heads and the head of the right femur.