Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet.

Twenty-seven previously treated club feet in 25 patients were evaluated retrospectively following tibialis anterior tendon transfer to the dorsum of the foot to correct residual dynamic supination deformity. In 11 feet, the transfer was combined with additional soft tissue and or bony procedures to treat other accompanying deformities. Electrophysiologically demonstrated peroneal weakness causing muscle imbalance contributed to the etiology of this dynamic deformity. At follow-up, none of the patients had dynamic supination deformity during ambulation. All showed active contraction of the transferred tibialis anterior tendon. There was no case of overcorrection. Functional and cosmetic results were assessed by parents and surgeons as being excellent. Tibialis anterior tendon transfer is recommended to correct residual dynamic supination deformity and to restore muscle balance after satisfactory correction of idiopathic club foot contractures.

Simple bone cysts treated by percutaneous autologous marrow grafting. A preliminary report.

We prospectively evaluated the percutaneous injection of autogenous bone marrow for the treatment of active simple bone cysts in ten consecutive children with cysts in the proximal humerus, proximal femur or tibia. The treatment included percutaneous biopsy, aspiration of fluid and the injection of autogenous bone marrow aspirated from the iliac crest. All the patients became painfree after a mean of two weeks and resumed full activities within six weeks. All ten cysts consolidated radiologically and showed remarkable remodelling within four months. Review at 12 to 48 months showed satisfactory healing without complications. Percutaneous injection of autologous bone marrow appears to be an effective treatment for active simple bone cysts.

Hemimetatarsal transfer: a unique solution for postaxial metatarsal duplication.

Many operations have been described for the reconstructive treatment of foot congenital anomalies involving multiplication of toes and metatarsi. We describe a surgical procedure designed to solve the problem of postaxial polydactily with complete duplication of metatarsi. We successfully performed hemimetatarsal transposition of the hypoplastic metatarsal bone with its intact metatarso-phalangial joint to the base of the extra metatarsus. We achieved good alignment of the lateral ray with restoration of the metatarsal weight-bearing touch points. Functional and cosmetic results of the procedure were excellent.

Muscle imbalance in the aetiology of idiopathic club foot. An electromyographic study.

We performed electrophysiological studies on both legs of 52 children, aged from 3 months to 15 years, with idiopathic club foot. In only nine (17%) was no abnormality found. Isolated peroneal nerve damage was seen in 14 (27%). Abnormality of both peroneal and posterior tibial nerves was found in five (10%). Four patients (8%) had evidence of isolated spinal-cord dysfunction, whereas combined spinal-cord and peripheral-nerve lesions were seen in 14 (27%). Six patients (11%) had variable neurogenic electrophysiological patterns. In 13 patients in whom the studies were repeated neither progression nor improvement of the electrophysiological parameters was observed. Pathological electrophysiological findings were found in 66% of conservatively-treated patients. In the 43 patients treated surgically, all 16 with fair and poor results had pathological electrophysiological findings and 12 required further operations. Multiplicity of the pathological findings was related to the severity of the deformity of the foot; normal studies represent a good prognostic sign. Electrophysiological studies are useful in idiopathic club foot with residual deformities after conservative or operative treatment. Our findings support the theory that muscle imbalance is an aetiological factor in idiopathic club foot.

Serrated (W/M) osteotomy: a new technique for simultaneous correction of angular and torsional deformity of the lower limb in children.

The serrated (W/M) osteotomy allows for simultaneous correction of angular and/or torsional deformities of the lower limb in the growing child. This osteotomy provides an attractive alternative to various types of upper tibial or distal femoral osteotomies. It eases the translations of the preoperative clinical and radiological evaluation to accurate angles during surgery. This type of osteotomy is stable, with large contact surfaces that provide excellent healing. Although no length is sacrificed, neither bone graft nor internal or external fixation is required.

Dysplasia epiphysealis capitis femoris. Meyer's dysplasia.

We made a prospective longitudinal clinical and radiological study of 18 children diagnosed as having dysplasia epiphysealis capitis femoris. Half the cases were bilateral. Boys were affected five times more often than girls. There were no symptoms or clinical signs in most but some of the bilateral cases had an inconsistent waddling gait. The imaging studies suggest that the cartilaginous proximal femoral epiphysis is hypoplastic, with delayed appearance of single or multiple ossification centres. Progressive improvement occurred and at an average age of five years and six months, there was complete fusion of all the ossific nuclei and normal density and texture of the epiphyseal bone. The end result was a round epiphysis with a slightly diminished height. The dysplasia is attributed to focal hypoplasia of the proximal femoral epiphysis.

A new orthosis for the management of clubfoot and other foot and leg deformities in infancy and early childhood.

A new orthosis designed to deal with unilateral or bilateral idiopathic clubfoot after successful conservative or surgical treatment was used to maintain the correction and to prevent recurrence. Once the neutral position of the heel was achieved, the orthosis was found to be very useful in improving the correction of the hind-foot and/or the forefoot. The first 50 patients treated with the orthosis showed a 92% compliance rate for an average period of 9-12 months.

Unilateral dysplasia of the superior articular facet of the axis: a case report.

A child with unilateral dysplasia of the superior articular facet of the axis is described. This congenital anomaly, due to incomplete ossification, may be a cause of torticollis, although no signs of instability were noted.

The clinical use of autologous marrow to improve osteogenic potential of bone grafts in pediatric orthopedics.

The high osteogenic potential of living autologous marrow cells can be combined with foreign bone to enhance new bone formation. Xenogeneic bone was combined with autologous red marrow and used in 23 patients aged 5-17 years. Kiel bone was impregnated with marrow aspirated from the iliac crest and, apart from one case of lesion recurrence, gave excellent results in all patients under conditions covering a wide range of indications for bone grafting. Unlimited supplies of xenograft bone and other bone substitutes can be rendered osteogenic by a simple procedure. Combining fresh autologous red marrow with other types of bank bone allograft or xenograft, or even with biological or synthetic biocompatible material that favors the induction of new bone, may provide even better results.

Residual adduction of the forefoot. A review of the Turco procedure for congenital club foot.

Forty-four feet in 28 children previously treated by a one-stage posteromedial release operation (the Turco procedure) were reviewed clinically and radiologically to determine the cause of residual adduction of the forefoot. In 21 clinically adducted feet (48%) the main cause of residual deformity was metatarsus varus alone or metatarsus varus in spite of talonavicular overcorrection; in five feet the cause was talonavicular subluxation. There was no residual adduction in 23 feet (52%) but only 12 had normal radiographic measurements. In the remaining feet, various forms of spurious correction of metatarsus varus and talonavicular subluxation or both were seen, resulting in normal-looking feet. Recession of the origin of abductor hallucis and release of the short plantar muscles and fascia at the time of posteromedial release is recommended. The forefoot adduction was satisfactorily corrected in 91% of the feet subsequently operated on using this modified procedure.

An analysis of the results of a modified one-stage posteromedial release (Turco operation) for the treatment of clubfoot.

Between 1971 and 1977, posteromedial release was performed on 47 feet of 30 children 9 months to 4 years of age. At review, full correction of equinus was achieved in 98%, heel varus in 91%, and cavus in 85%, but in only 50% of feet with forefoot adduction. Between 1978 and 1982, surgery was performed on 22 feet of 18 children 3-10 months of age. Recessions of the abductor hallucis and short plantar muscles and fascia were also performed at operation. Correction of equinus, heel varus, and cavus demonstrated results similar to those of the earlier group, but forefoot adduction was also satisfactorily corrected in 91% of feet.

Mycobacterium abscessus (M. chelonei) infection of the knee joint: report of two cases following intra-articular injection of corticosteroids.

In 2 patients (3 knees) acute infectious arthritis of the knee developed following intra-articular injection of corticosteroids. The pathogenic organism responsible for the infection was found to be Mycobacterium Abscessus (M. Chelonei). Diagnostic difficulties were encountered due to the rarity of such infections and elusive identification of the organism with routine laboratory procedures. Therapeutic approaches necessitated combined radical surgical procedures together with antituberculosis drugs. Surgical treatment also afforded correct and definitive identification of the organism, from material obtained at operation. Although these mycobacteriae were found to be resistent to antituberculosis drugs, these same drugs proved effective clinically.

Coxa vara, avascular necrosis and osteochondritis dissecans complicating solitary bone cysts of the proximal femur.

In 2 children with cysts in the upper end of the femur, there were 3 complications: coxa vara, avascular necrosis and osteochondritis dissecans. Coxa vara occurred in both cases and was due in 1 case to pathological fracture, and in the other case to growth disturbance. Avascular necrosis of the femoral head, a hitherto unreported complication of bone cyst of the upper end of the femur occurred in 1 patient following pathological fracture and resulted in osteochondritis dissecans of the femoral head.

Benign osteoblastoma of the calcaneous.

This is a case report of a 29-year-old male with a chondroblastoma of the os calcis successfully treated by almost total resection of the tuber calcanei without sacrifice insertion of the tendon achilles.