Walking capacity of children with clubfeet in primary school: something to worry about?

Although the main aim of clubfoot correction is to create a foot without limitations in daily activities and sport, studies on the walking capacity of children with corrected clubfeet are rare. In this cross-sectional study, the outcome of the six-minute walking test in 44 children with clubfeet (16 unilateral and 28 bilateral, mean age 8.57±2.45 years) was compared with the reference values of Geiger, clinical status measured with the Clubfoot Assessment Protocol (CAP), and regression analysis used to calculate which CAP subgroup predicts walking capacity. The mean walking capacity was decreased to 79% (P<0.001) and was not influenced by unilaterality or bilaterality (P=0.437). The subgroup CAP morphology was a significant predictor (R=0.103; P=0.034). Knowing that walking capacity is only slightly decreased can help adjust expectations and set goals for training.

Arthrodesis of the first metatarsophalangeal joint: a retrospective analysis of plate versus screw fixation.

Arthrodesis of the first metatarsophalangeal joint is a commonly accepted technique to treat various afflictions of the hallux. Many techniques have been described to fixate the arthrodesis. However, no superior fixation technique has been identified in regard to nonunion. We performed a retrospective analysis of first metatarsophalangeal joint arthrodeses in our clinic from January 2000 to April 2010, focusing on plate and screw fixation. Our aim was to identify the best fixation construct in regard to fusion rates and radiologic nonunion. We identified 72 arthrodeses performed using 1 oblique (n = 24) or 2 crossed (n = 21) lag screws or a plate (n = 13) or a plate augmented with plantar lag screw fixation (n = 14). Our analysis showed that plate fixation alone results in significantly fewer nonunions than single screw fixation. A comparison of the other fixation types showed no significant differences with regard to nonunion. Although our analysis showed that plate fixation alone is superior to single screw fixation, no definitive conclusion can be drawn owing to methodologic shortcomings. We believe a randomized controlled trial with larger sample sizes is necessary to find the clinically superior fixation technique.

[Increasing leg length discrepancy in multiple enchondromatosis]. / Progressief beenlengteverschil door multipele enchondromatose.

BACKGROUND: Ollier's disease (multiple enchondromatosis) is a rare non-hereditary condition characterised by the occurrence of multiple enchondromas, usually unilateral and asymmetrically distributed in the metaphyseal regions of the long bones and in the phalanges of the hand and foot. CASE DESCRIPTION: A 10-year-old girl visited our outpatients' department with growth retardation of the left leg. Radiographic examination showed reduced growth and deformities in the femur and tibia, confirmed by MRI and bone scan. Since the aetiology of the deformities was not clear, we consulted the Netherlands Committee on Bone Tumours who diagnosed Ollier's disease (multiple enchondromatosis). CONCLUSION: The pathogenesis of Ollier's disease possibly involves abnormalities in the signalling pathways controlling the differentiation of chondrocytes. Treatment is surgical and may consist of curettage and grafting of lesions, osteotomy, or Ilizarov fixation to correct deformities and length difference. Patients have a 5-50% risk of malignant transformation to chondrosarcoma, necessitating lifelong follow-up.

[Fewer blood transfusions after introduction of auto-transfusion system as part of hip- and knee-replacement surgery]. / Minder bloedtransfusies na invoering van autotransfusiesysteem bij heup- en knievervanging.

OBJECTIVE: To establish the effect of the introduction of an auto-transfusion system on the number of homologous blood transfusions required as part of total hip- and knee-replacement surgery. DESIGN: Prospective observational study. METHODS: The number of homologous blood transfusions required after total hip or knee replacement was compared between a group of 195 patients before and a group of 176 patients after introduction of an auto-transfusion system. The '4-5-6 Flexinorm' was strictly implemented when deciding to use homologous blood transfusion. Composition of the groups and the number of transfusion units of homologous blood (packed cells) required were compared using Student's t test and the chi2 test. In addition multivariate logistic regression analysis was used with the following variables as risk factors for requirement of homologous blood transfusion: gender, age, type of surgery and the use of an auto-transfusion system. RESULTS: After introduction of the auto-transfusion system there was a reduction in the number of transfusion units given in both the hip- and the knee-replacement group (83% and 98% respectively). The use of the auto-transfusion system was the only variable for prediction of the requirement for homologous blood transfusion in the logistic regression model. CONCLUSION: After the introduction of an auto-transfusion system there was a reduction in the number of homologous blood transfusions required as part of total hip and knee surgery.