Isolated bifid rib: clinical and radiological findings in children.

BACKGROUND: Bifid rib is usually asymptomatic but sometimes occurs associated with other pathological conditions. The aim of this study was to investigate clinical and radiological characteristics in children with bifid rib. METHODS: Nine children with the diagnosis of bifid rib between 2005 and 2010 were reviewed. Chest radiography and computed tomography (CT) were performed in all patients, and 3-D images were additionally reconstructed in six patients. RESULTS: Five girls and four boys with a mean age at presentation of 4.2 years had various types of unilateral bifid rib. Seven patients complained of a chest wall mass, whereas two patients whose costal abnormalities were incidentally detected on chest radiography were asymptomatic. Bifid ribs were confirmed on plain radiographs in six patients, while the other three patients were finally diagnosed on reconstruction 3D-CT. One patient with a flared rib on a radiograph showed bifurcation of the costal cartilage on 3D-CT. The other two patients with upper rib abnormalities on radiography had downward extension of the cervical or first rib articulating with the upper branch of the bifid first or second rib, respectively. CONCLUSION: Reconstruction 3D-CT can demonstrate complicated thoracic abnormalities in patients with atypical appearance of the rib on plain radiographs. An isolated bifid rib may require no further intervention.

The biomechanical effect of the sensomotor insole on a pediatric intoeing gait.

Background. The sensomotor insole (SMI) has clinically been shown to be successful in treating an intoeing gait. We investigated the biomechanical effect of SMI on a pediatric intoeing gait by using three-dimensional gait analysis. Methods. Six patients with congenital clubfeet and four patients with idiopathic intoeing gait were included. There were five boys and five girls with the average age at testing of 5.6 years. The torsional profile of the lower limb was assessed clinically. Three-dimensional gait analysis was performed in the same shoes with and without SMI. Results. All clubfeet patients exhibited metatarsal adductus, while excessive femoral anteversion and/or internal tibial torsion was found in patients with idiopathic intoeing gait. SMI showed significant decreased internal rotation of the proximal femur in terminal swing phase and loading response phase. The internal rotation of the tibia was significantly smaller in mid stance phase and terminal stance phase by SMI. In addition, SMI significantly increased the walking speed and the step length. Conclusions. SMI improved abnormal gait patterns of pediatric intoeing gait by decreasing femoral internal rotation through the end of the swing phase and the beginning of the stance phase and by decreasing tibial internal rotation during the stance phase.