Subject(s)
Femur Head Necrosis , Femur Head , Humans , Acetabulum , Patients , Retrospective StudiesSubject(s)
Ankle , Foot , Periodicals as Topic , Randomized Controlled Trials as Topic/standards , Research Design/trends , HumansSubject(s)
Femoral Neck Fractures , Femur Head/blood supply , Adult , Arteries , Epiphyses/blood supply , Femoral Artery , HumansABSTRACT
We are reporting an unusual combination of Hawkins Group I fracture of the neck of left talus in association with Salter Harris Type III distal tibial epiphyseal injury of medial malleolus in a child with cerebral palsy and hemiplegia of contralateral limbs and discussed the possible mechanism as well as management. Fractures of medial malleolus usually occur in Hawkins Group III fracture-dislocations in adults. Forced dorsiflexion of talus against the anterior edge of tibia appears to be the accepted common mechanism, despite limited experimental and clinical evidence incriminating axial compression. Fracture of medial malleolus implicates supination. We managed this unusual pattern of injury conservatively. At 15 months, the child was asymptomatic with no radiological evidence of avascular necrosis of body of talus or growth disturbance of distal tibial epiphysis.
Subject(s)
Ankle Injuries/diagnostic imaging , Fractures, Bone/diagnostic imaging , Talus/injuries , Tibia/injuries , Ankle Injuries/classification , Ankle Injuries/therapy , Casts, Surgical , Cerebral Palsy/complications , Child , Epiphyses/diagnostic imaging , Epiphyses/injuries , Fractures, Bone/classification , Fractures, Bone/therapy , Hemiplegia/complications , Humans , Male , Radiography , Talus/diagnostic imaging , Tibia/diagnostic imagingABSTRACT
BACKGROUND: Flat foot in children during the first years of life evokes significant parental concern. Flat foot, intoeing and femoral anteversion may well be differential dimensions of developmental pathodynamics with potential for inter-related developmental correction. While correlation of femoral anteversion with intoeing is documented, its relationship with flat foot remains unclear. OBJECTIVE: The aim of this prospective study is to investigate the relationship between flat foot and internal rotation of hip, indirectly femoral anteversion. METHODS: 651 Children, 339 boys and 312 girls, aged 3-6 years, were examined and Contact Index II for flat foot as well as internal rotation of hip measured. 82 children with other foot and leg deformities were excluded from further analysis. RESULTS: Out of 569 children, 95 (16.7%) had flat feet--56 bilateral, 39 unilateral--with Contact Index II of 0.88 or above. All children with flat feet (and none of the normal 474) had raised internal rotation of hip (mean 69.9 degrees, range 62-80 degrees). CONCLUSION: Regression analysis established an unequivocal and highly significant statistical relationship between flat foot and increased internal rotation of hip (F=168.1, p<0.001, r=0.53) in children between 3 and 6 years.
