Island nail flap in the treatment of foot macrodactyly of the first ray in children: report of two cases.

PURPOSE: We evaluated the result of a combined single-stage surgery in the treatment of first ray macrodactyly in children. INTRODUCTION: Macrodactyly is a rare congenital abnormality that involves thickening of both the soft tissue and bone of the affected digits. It is more frequent in fingers than toes, where there is less neural involvement. Increased growth is also seen in neurofibromatosis, hemangiomatosis, arteriovenous malformations, congenital lymphedema, and syndromes such as Klippel-Trenaunay-Weber syndrome and Proteus syndrome. The goal of treatment is to obtain a pain-free, functional foot that can accommodate normal shoes. Treatment of macrodactyly of the first ray generates numerous difficulties since ray resection, which has been recommended for other toes as a means to of shortening and narrowing the foot, cannot be performed. In addition to this, cosmetic results are better if the nail is preserved. METHODS: We retrospectively reviewed our cases of first ray macrodactyly treated by a single-stage multiple-technique procedure. RESULTS: We obtained satisfactory results, in that same-sized shoes could be worn on by our patients and patients and family were happy with the outcome. However, one of our cases patients lost the nail 10 months postoperatively. CONCLUSIONS: We believe that island-nail transfer in children obtains excellent results.

Nota clínica. Complicaciones del método Ponseti: Edema de miembro por efecto ventana / Complication of Ponseti’s method: Edema member for windows effect

El pie equinovaro es la deformidad congénita más frecuente, afectando a 1 de cada 1000 recién nacidos vivos. El método más aceptado para su tratamiento es el método Ponseti, que consiste en la utilización de yesos seriados, encaminados a corregir las deformidades asociadas a dicha deformidad. Varias son las complicaciones que pueden aparecer durante el enyesado seriado, aunque la mayoría son banales. En nuestro centro hemos diagnosticado 5 casos de edema de miembro por efecto ventana asociado a este tratamiento. En todos los casos, esta complicación ha aparecido tras retirar el yeso post-tenotomía, previo a la colocación de la férula de abducción. Asociamos esta complicación con la rigidez de las vendas de algodón utilizadas, lo que nos ha llevado a cambiarlas por otras sin trenzado, mucho más distensibles. Actualmente no ha aparecido ningún nuevo caso

The clubfoot is the most common birth defect, affecting 1 in 1000 live births. The most accepted method for treatment is the Ponseti method which consists of serial casting, which corrects all the deformities associated with this deformity. There are several complications that can arise during serial casting, although most are banal. In our center we have diagnosed 5 cases of edema member for windows effect with this treatment. In all cases, this complication has appeared after removal of the post-tenotomy cast, prior to using the abduction brace. We associate this complication with the rigidity of the cotton bandages used, which has led us to change them for other without mesh, much more distensible. Currently, no new caseshave appeared

Lower Extremity Fibro-Adipose Vascular Anomaly (FAVA): A New Case of a Newly Delineated Disorder.

The acronym FAVA (Fibro-Adipose Vascular Anomaly) has been recently given to a distinct vascular entity that is characterized by fibrofatty infiltration of muscle, unusual phlebectasia with pain, and contracture of the affected extremity. We report a new case of FAVA in a 10-year-old girl with pain in her right lower leg and equinus contracture. As in our case, FAVA typically presents in young females with calf involvement and limited ankle dorsiflexion with local pain. FAVA should be considered as a differential diagnosis when evaluating vascular anomalies in the lower extremities.

Physeal fracture of the distal femur in a newborn: role of arthrography.

Making the diagnosis of a physeal separation of the distal end of the femur in a newborn is a true challenge. The radiological diagnosis is not always simple and a high index of suspicion is needed. Also, knowing the age of appearance of the ossific nuclei helps in reaching a diagnosis. However, it is imperative to perform a differential diagnosis with other causes that may compromise the life of the newborn. An early diagnosis and adequate treatment are fundamental in avoiding permanent deformity of the affected limb. We present a case report, along with a review of the literature, to describe the clinical and radiological findings that aid in reaching a diagnosis and giving the proper treatment. We also point out the importance of the role of the arthrography and closed reduction as an alternative to simple open reduction.