Treatment of residual clubfoot deformity--the "bean-shaped" foot--by opening wedge medial cuneiform osteotomy and closing wedge cuboid osteotomy. Clinical review and cadaver correlations.

Six patients (seven feet) previously treated surgically for clubfoot had a "bean-shaped" foot. Opening wedge medial cuneiform and closing wedge cuboid osteotomies were done, resulting in good resolution of the prominent midfoot supination and forefoot adductus without significant soft tissue dissection and invasion of growing areas in the foot. Cadaver reproductions show that the cuboid closing wedge is responsible for the change in the midfoot, whereas the cuboid and cuneiform osteotomies both contribute to the change in the forefoot.

MR imaging findings in patients with bone-chip allografts.

Increasing use of MR to evaluate primary bone neoplasms has stimulated numerous articles on the initial assessment of these lesions. However, scant MR literature has been written about the postoperative MR appearance. We studied the MR appearance of lesions treated by curettage followed by packing with cancellous bone-chip allograft. We retrospectively reviewed the MR scans of 18 consecutive patients treated in this way. Pathologic diagnoses of these lesions were confirmed according to commonly accepted criteria. The allograft sites showed a distinctive pattern of speckled bright signal on T1-weighted images in eight cases. Thirteen of 18 grafts showed a whorled or speckled pattern of increased signal on the T2-weighted images. Only four allograft regions had predominantly low signal on both T1- and T2-weighted images. Two of 18 patients had recurrent tumor proved by open biopsy. MR images in these cases showed areas of homogeneous signal that replaced areas of speckled hyperintensity on both T1- and T2-weighted images. In both these recurrences the tumor had signal intensity similar to that seen on the preoperative MR study. We conclude that knowledge of the MR appearance of cancellous bone chip allografts is important to avoid misinterpreting areas of high signal on T1- or T2-weighted images as areas of recurrence of tumor and/or hemorrhage.