A congenital mucocele of the anterior dorsal tongue.

We report on a new-born with a congenital mucocele on the anterior dorsal side of the tongue. The presentation as well as the differential diagnosis of congenital oral swellings is discussed. Because of breastfeeding problems the mucinous swelling was incised and drained two days after birth. Immediately after drainage the swelling disappeared. Congenital oral swellings are rare. Most of them are mucoceles. Post-partum treatment is surgically, but spontaneous remission has been described. High incidence of recurrence should be taken into account when (micro-)marsupialization or incision as sole treatment is performed.

A common HLA phenotype in slipped capital femoral epiphysis?

Studies from three different countries have linked the HLA B12 and DR4 antigens with slipped capital femoral epiphysis (SCFE). We questioned whether our patients shared in common either of these antigens. HLA phenotype was determined in 7 patients with SCFE, two of whom were brothers with almost identical haplotypes. The B12 antigen was found in none of our patients and the DR4 in only 3. Neither of the 2 brothers held the DR4 antigen. The commonest antigens (also shared by the 2 brothers) were B35, present in 5 and DR52 in 4 of 7 patients. We conclude that neither the previously described B12 nor the DR4 antigen can reliably serve as genetic markers for SCFE in our region.

Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure.

We describe a case of infected nonunion of the radius with extensive bone loss in an 11-year-old boy treated by centralization of the ulna. The technique used differs from the original Hey Groves procedure in that it preserves the distal end of the ulna with its important triangular fibrocartilage complex, thereby retaining stability and contour of the wrist joint. Our patient obtained a functionally and cosmetically satisfactory, stable forearm and wrist. We present the technique as a useful armament in the management of extensive bony defect of the radius arising from trauma or infection.

Anterior disc protrusion as a cause for abdominal symptoms in childhood discitis. A case report.

STUDY DESIGN: A case report on infectious spondylitis in a child who reported abdominal pain and whose magnetic resonance image revealed anterior herniation of disc space contents. OBJECTIVES: To correlate the direction of disc protrusion in infectious spondylitis with clinical manifestations. SUMMARY OF BACKGROUND DATA: Previous studies have correlated posterior protrusion of disc space contents in infectious spondylitis with a clinical presentation of back pain, paravertebral muscle spasm, hamstrings tightness, and radiculopathy. None has connected anterior herniation of disc phlegmon with abdominal pain. METHODS: In addition to plain radiography and bone scintigraphy, magnetic resonance imaging was used to confirm the diagnosis of infectious spondylitis in a 6-year-old child with abdominal pain. Regular review for 1 year included repeat magnetic resonance imaging at 3 months. RESULTS: Initial magnetic resonance imaging revealed characteristic changes associated with infectious spondylitis throughout the L5-S1 vertebra-disc-vertebra unit and anterior protrusion of the disc material and phlegmon. Magnetic resonance imaging at follow-up examination 3 months later demonstrated complete resolution of the disc herniation. CONCLUSION: Future magnetic resonance imaging studies should correlate direction of disc herniation with age and symptomatology to validate or improve classifications of infectious spondylitis, which presently include only the last two parameters.

Percutaneous epiphysiodesis using transphyseal screws (PETS).

We describe a new technique of percutaneous epiphysiodesis using transphyseal screws (PETS) and our experience with it in 32 cases of limb-length inequality and nine angular knee deformities. A subgroup of 18 patients with postfracture limb overgrowth formed a clinical model for study of the real efficacy of PETS. It proved a reliable method with few complications and many advantages such as simplicity of technique, short operating time, rapid postoperative rehabilitation, and reversibility. Bone-length inequality decreased from a preepiphysiodesis average of 2.47 cm (range, 1.5-4.6) to 0.51 cm at skeletal maturity. The tibiofemoral angle reduced from a preoperative average of 7.66 degrees to 0.86 degrees at maturity. The screws began to exert significant growth inhibition within 6 months of insertion, slowing down the distal femoral and upper tibial physes by 68 and 56%, respectively. They achieved maximum growth retardation over the ensuing 12 months, slowing down the distal femoral physis by 89% and the proximal tibial physis by 95%. At skeletal maturity, total femoral growth was 45% and total tibial growth was 52% that of the normal side. Key

Fracture of the upper radius with ipsilateral dislocations of the elbow and superior radio-ulnar joints. A case report.

We report the rare combination of a closed fracture of the upper third of the radius with ipsilateral posterior dislocation of the elbow joint and disruption of the superior radio-ulnar joint. Although in the Bado classification there is a fourth type that describes fractures of both radius and ulna with dislocation of the superior radio-ulnar joint, it does not include the injury we report. We review of the literature and put forward an extension of Bado's classification so that fractures of either, or both, the radius and ulna associated with pericubital dislocations will be included.

Two parallel linear densities on lateral radiographs of the lumbosacral spine: neither iliopectineal lines nor basis ossis sacri.

Two parallel radiodense lines are constantly seen on lateral radiographs of the lumbosacral spine. Whether they originate from the pelvis or sacrum is unclear. Using metallic wire markers, we performed a radiographic investigation on bony skeletons to define their origins and anatomical locations. Our study demonstrates that each arises from the sharp, well-defined bony ridge which forms the anterosuperior boundary of the auricular surface for articulation with the sacrum on either side. Each ridge lies along the medial border of the iliac fossa and represents an increase in compact bone in response to weight transmission. These lines have useful applications for they provide fixed radiographic landmarks on the bony pelvis for certain angular measurements in orthopaedics.

Nerve palsy during femoral lengthening: MRI, electrical, and histologic findings in the central and peripheral nervous systems--a canine model.

Six dog's femurs were lengthened until complete peroneal palsy was present. Ten-24 days later MRIs of the spinal cords were normal. EMGs located lesions at the spinal foramina in five dogs and at the lumbar plexus in one. In all dogs nerve conduction below the lesions was normal and amplitudes were diminished. Muscle histology confirmed neurogenic atrophy. Nerve histology at the sites of the lesions showed myelin and axon changes, but there was no Wallerian degeneration at or distal to those sites. Thus, the nerve lesions were either a variant of Sunderland first degree injury or were developing into second degree.

Rotational remodeling of malrotated femoral fractures: a model in the rabbit.

It is estimated that 20-40% of femoral fractures in children heal in malrotation, yet few patients later complain. To determine if malrotation corrects spontaneously, midshaft osteotomies were made in femurs of 16 rabbits aged 8 weeks and the distal fragments were internally rotated 45 degrees, where they were held with external fixators. The animals were killed between week 0 and week 17. Version of the femoral necks was determined by computed tomography scan (CT). The version altered rapidly toward normal from weeks 0 to 4 and then remained stable, with an average rotational remodeling of 55%.

Prophylactic bypass grafting of the prepseudarthrotic tibia in neurofibromatosis.

Nine cases of prophylactic bypass grafting of the prepseudarthrotic tibia in neurofibromatosis were reviewed. The age at operation ranged from 0.9 to 9.2 years. The graft used was variously the opposite tibia, autograft rib, allograft fibula, and allograft bone chips in combination with autograft or allograft. All patients were braced postoperatively. Follow-up ranged from 2.9 to 18.8 years. Allograft bone chips resorbed in every case. All autografts and the one fibular allograft united with the tibia. Three tibias required further procedures to obtain union after development of pseudarthrosis, whereas six remained intact.

Physeal remodeling after internal fixation of slipped capital femoral epiphyses.

Rounding off the femoral neck metaphysis helps improve hip function in slipped capital femoral epiphysis (SCFE). Remodeling by physeal growth, not previously reported, may also contribute. By studing the changes in physeal-shaft angle after internal fixation (IF), we found evidence of physeal remodeling in one of 21 mild, five of 23 moderate, and in all of 11 severe slips. Although the amount of remodeling averaged 11.7 degrees, it occurred in 100% of severe slips (p less than 0.001). This support the use of initial pin fixation and a wait of at least 2 years before realignment femoral neck osteotomies are considered.

Movement of the femoral head after Salter osteotomy for acetabular dysplasia.

A Salter innominate osteotomy is used to treat acetabular dysplasia, but reports of its effects on the position of the femoral head are few and conflicting. Lateral shift would increase the resultant forces acting on the joint and be detrimental. We studied 15 Salter innominate osteotomies and demonstrated that a correctly performed osteotomy does not significantly alter the distance from the centre of the femoral head to the midline of the body. Stereophotogrammetry was used in three patients to delineate the axis of rotation of the distal acetabular fragment and determine the locus of movement of the centre of the femoral head about it. Our results explain why the Salter osteotomy does not lateralise the femoral head.

Salter-Harris type III fracture of the proximal humeral physis.

Salter-Harris type III, IV and V injuries of the proximal humeral physis are rare. We report an undisplaced Salter-Harris type III injury of the humeral head physis in a 10-year-old girl. The fracture united with non-operative treatment.