Toe component excision in postaxial polydactyly of the foot.

BACKGROUND: Polydactyly of the fifth toe is the most common congenital malformation of the forefoot, and no consensus has been reached as to which toe component should be excised or by which surgical technique. The purpose of this study was to evaluate the results of the operative treatment of postaxial polydactyly and to offer treatment guidelines. METHOD: We retrospectively reviewed the details of 27 patients with postaxial polydactyly (36 feet) treated from September 2004 to March 2010. To select the dominant toe of postaxial polydactyly, we evaluated the morphological and radiological configurations. To excise the medial toe, we treated the polydactyly by dorsal rectangular flap and a full-thickness inguinal skin graft. To excise the lateral toe, we treated the polydactyly by racket-shape incision. Patient satisfaction indices were evaluated on the basis of responses to the PSQ-10 patient satisfaction questionnaire and clinical outcomes. RESULT: Overall surgical outcomes were satisfactory with the exception of 2 cases of skin graft problems. Eighteen of the 36 reconstructed toes were smaller than the normal toes, but valgus deformity was observed in only 3 cases. CONCLUSION: The described medial toe excision technique and the devised toe selection algorithm were able to satisfy functional and cosmetic requirements.

Slipped capital femoral epiphysis following fracture of the femoral neck: a case report.

Reports on cases of femoral neck fracture complicated by a slipped capital femoral epiphysis associated with avascular necrosis and coxa vara deformity in children are extremely rare. In this case report, we describe a patient who had complications of a slipped capital femoral epiphysis with avascular necrosis and coxa vara deformity after a Delbet type III left femoral neck fracture. We also describe the surgical treatment to overcome these complications.

Spontaneous reduction finding: magnetic resonance imaging evaluation of segmental instability in spondylolisthesis.

STUDY DESIGN: Retrospective chart review. PURPOSE: To assess whether spontaneous reduction of spondylolisthesis, as seen on magnetic resonance imaging (MRI), is related to the degree of segmental instability and low back pain. OVERVIEW OF LITERATURE: The flexion-extension radiographs obtained in the sagittal plane are frequently used when segmental instability of spondylolisthesis is evaluated. METHODS: We retrospectively reviewed 137 patients and measured the differences of the percentage of sagittal translation and sagittal angulation to determine the segmental instability between the flexion and extension radiographs, and the spontaneous reduction on MRI. We then compared the degrees of segmental instability and the degrees of spontaneous reduction. To assess the effect of low back pain on segmental motion in regards to the flexion-extension radiographs, we compared the preoperative visual analogue scales (VAS) score for low back pain between the more and the less spontaneous reduction groups. RESULTS: The mean degree of spontaneous reduction was 5.2%. A statistically significant correlation was found between the sagittal translation on the flexion-extension radiographs and the degree of spontaneous reduction (r = 0.557, p < 0.001) and between the sagittal angulation on the flexion-extension radiographs and the degree of spontaneous reduction (r = 0.215, p = 0.012). The preoperative VAS scores for low back pain of the more spontaneous reduction group and the less spontaneous reduction group were 4.6 and 3.6 points, respectively, and this difference was statistically significant (p = 0.002). CONCLUSIONS: Spontaneous reduction of spondylolisthesis on MRI was found to be closely related to segmental instability, and the degree of spontaneous reduction seen on MRI could be useful for the evaluation of segmental instability in patients with spondylolisthesis, especially with severe low back pain.

Occipitocervical reconstruction through direct lateral and posterior approach for the treatment of primary osteosarcoma in the atlas: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To report a new surgical technique of the primary cervical osteosarcoma in the atlas. SUMMARY OF BACKGROUND DATA: Primary osteosarcoma of the atlas is extremely rare. This is the first report that describes a surgical treatment of the primary osteosarcoma in the atlas. Resection of an osteosarcoma in the atlas is very difficult because of the complex and important anatomic structures that surround it, and secure reconstruction of the atlas is difficult as well. METHODS: A 48-year-old man was referred to our institute with a 10-month history of a palpable painful mass on the right posterior neck. His neck mass was diagnosed as chondroblastic osteosarcoma by open bone biopsy. The plain radiograph of the lateral cervical spine revealed the osteoblastic lesion of the vertebra and an extraosseous mass formation from the C1 to C3 vertebrae. Computed tomography of the cervical spine revealed approximately a 7 × 3 × 7 cm-sized extraosseous calcified mass that originated from the right lateral mass of the atlas. The magnetic resonance imaging of the cervical spine did not show any spinal cord compression. RESULTS: The patient underwent excision of this tumor using the direct lateral approach and reconstruction of the lateral mass of the atlas. On gross examination of the mass, there was a reactive thin membrane ("pseudomembrane") between soft tissue and tumor. At 3 months after surgery, the computed tomographic scan showed the solid fusion state of the occipitocervical joint. He rarely complained of any problems except for mild limitation of neck motion. CONCLUSION: We report a rare case of complete excision of an osteosarcoma of the C1 lateral mass in our patient via a direct lateral and posterior approach to secure additional fixation of occipitocervical joint. We describe our technique for reconstructing the lateral mass of the atlas. This reconstruction technique will also be applicable to other resection surgeries involving the occipitocervical junction.

Comparison of static and mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty.

Infection after total knee arthroplasty (TKA) is a devastating complication, and two-stage reimplantation has evolved as an effective treatment option. This study was undertaken to compare the clinical results and radiological changes associated with static or mobile cement spacer placement for the treatment of infected TKA. Between July 2000 and February 2007, 36 consecutive patients were treated by two-stage reimplantation using antibiotic-impregnated cement spacers (AICS) for infected TKAs. Static spacers were used in 20 knees and mobile spacers in 16 knees. Clinical outcomes included success rates of TKR revisions, ranges of motion (ROM), and Hospital for Special Surgery knee scores (HSS), pain and function scores of the Knee Society (KS), joint exposure methods, and bone loss. In this study, mobile spacers provided better ranges of motion and functional knee scores without concomitant increases in infection rate and bone loss in the initial and mid-term periods.