Osteoid osteoma of the talus.

The talus is a rare site of predilection for osteoid osteoma. This tumor, in its juxta-articular position, presents particular clinical and pathological features. Three cases of subperiosteal osteoid osteoma are discussed in patients aged 15, 17 and 25 years. In diagnosis, a basic role is played by awareness of the disease, which must lead to the use of bone scan, indicating the site of the pathological lesion, which may be difficult to determine because of subtle radiographic modifications, and particularly because of long-term changes in the symptoms. Radiographic examination (standard x-rays, enlarged x-rays), often characterises and reinforces what is diagnostically suspected. CAT clearly shows the features and type of osteoid osteoma in relation to the adjacent structures. Sequential angioscintigraphy, based on the captation curve of the radionuclide, may suggest the nature of the lesion, subsequently confirmed by the macroscopic picture and histological examination.

Echinococcosis: intramuscular localization.

Localization of hydatidosis in the musculoskeletal system is a rare occurrence, and generally involves the skeleton. A case reported here in which the muscular localization of hydatidosis followed hepatic and pulmonary localizations treated surgically. 1) Muscular localization seems to be related to the regional circulation; 2) diagnosis may be done by echography, CT scan, RMI and immunological tests with ELISA and RIA methods; 3) basic steps during surgery, which constitutes the treatment of choice, involve the prevention of anaphylactic shock and the inactivation of the cyst; 4) chemotherapy is limited to cases in which it is not possible to perform radical surgery, to the prevention of postoperative recurrence, and to cases which cannot be treated surgically.

Lumbar spinal artery syndrome. Report of an unusual case.

The literature on the lumbar spinal artery syndrome and the anatomy of the vascular supply to the spinal cord is discussed. The authors report a case which is exceptional in that it occurred in a child aged 4 years after apparently trivial trauma.

Osteosarcoma of the proximal femur and humerus in children treated by resection, endoprosthesis and complementary chemotherapy.

Three cases of osteosarcoma of the proximal femur and humerus in children are reported. They were all highly malignant. They were treated by radical resection and prosthetic replacement with complementary chemotherapy. At 6 months, 2 years and 7 months, and 3 years and 2 months respectively they show no signs of local recurrence or metastases.

Congenital clubfoot: results and therapeutic guidelines.

The authors report the results observed between 5 and 11 years after surgery in 100 cases of congenital clubfoot treated by posterior release and another 100 cases treated by combined posterior and medial release. On the basis of their experience, they believe that: 1. Grade 1 clubfoot can be successfully treated conservatively; 2. Grade 2 and grade 3 clubfoot must always be treated by complete posterior and medial release; 3. The best age for surgical intervention is around the age of 3 months; 4. In the first three months of life, manipulation and plaster casts should be used to try to correct the deformity.

Post-traumatic genu valgum in children.

The authors present 16 cases of post-traumatic genu valgum in children and discuss the pathogenesis of the deformity. In addition to mechanical factors (imperfect reduction of the fracture, inadequate immobilization, "bow string" effect of the intact fibula and the antero-lateral muscles of the thigh, altered load-bearing axis) there are biological factors of much greater importance. These are damage to the lateral aspect of the proximal growth cartilage of the tibia, with augmented growth on the medial side due to stimulation at the fracture site and periosteal detachment. All our cases were treated by osteotomy and there were 7 partial relapses, the causes of which are discussed. Osteotomy is tantamount to a second fracture, so must have regard to the pathological factors related to relapse. The authors recommend that corrective osteotomy of the tibia should always be associated with osteotomy of the fibula to avoid the "bow string" " effect. They also advise over correction of the deformity by about 5 degrees and immobilization in a full spica plaster to ensure maintenance of correction and rapid healing. For the same reason, perfect contact between the osteotomised surfaces is essential.

Tenomyoplasty of the flexor muscles in the surgical treatment of congenital recurvatum, subluxation and dislocation of the knee.

The writers present eight cases of congenital recurvatum or dislocation of the knee in which tenomyoplasty of the flexor muscles of the knee was performed. The operation was the only one used in cases with flexion greater than 60 degrees, while in cases of more severe loss of flexion, it was supplementary to mobilisation of the quadriceps according to Judet's technique. The technique of tenomyoplasty is described and the results are reported. These are considered to be favourable.

Surgical treatment of metatarsus varus during the growth period.

The writers describe their experience in the treatment of congenital metatarsus varus. They describe an original technique for anterior transfer or shortening of peroneus brevis which they consider to be indicated when the varus deformity is less than 15 degrees and is correctable manually. They also describe Heyman's technique and give their results in twenty-five cases. They consider that this operation is indicated only for varus deformity of the forefoot exceeding 15 degrees which is correctable manually. In both these techniques it is essential that the hindfoot should be in the correct midline axis. Where manual correction of the hindfoot is not possible they advise Dillwyn Evans' operation. In varus deformity of the 1st metatarsal exceeding 15 degrees, and not correctable manually, they suggest osteotomy of the base of this bone, displacing it the correct degree and fixing it with a wedge of homoplastic bone inserted into the gap.

Osteogenesis imperfecta: results obtained with the Sofield method of surgical treatment.

The authors report the results obtained in thirteen patients with osteogenesis imperfecta who were treated by the Sofield operation. This operation is indicated both in the congenital and delayed forms of the disease. The results are promising: prevention of deformities and fractures in a high percentage of cases, recovery of the ability to walk in all the patients. The incidence of complications was low, infection being the most serious. Although the use of extending rods reduces the number of reinterventions, it does not appear to improve the results and carries the risk of a greater number of complications. However, the authors have no experience of this particular technique.

Massive homogenous osteo-articular bone grafts. Long term results.

The authors present a long term review of thirty cases of massive homogenous bone grafts carried out at the Istituto Ortopedico Rizzoli between 1967 and 1971. Thirty one of these were either complete or partial diaphyseo- articular grafts. The lesions for which the operations were performed were: twelve giant cell tumours; one Ewing's tumour; two reticulosarcomas; eight osteosarcomas; six chondrosarcomas; one loss of bone substance from trauma, one echinococcosis of the femur and one aneurysmal bone cyst. In some of these cases amputation or disarticulation had been advised but refused by the patient. Follow up three and a half to five years after operation showed complete incorporation of the graft in eight cases, partial incorporation in live, and resorption in four. In the remaining fifteen cases the follow up was terminated by early death, recurrences, infection or intolerance with rejection. In conclusion, the authors recommend that massive osteoarticular homogenous grafts should be confined to the substitution of unicondylar lesions as these offer greater contact with the host bone and therefore a greater possibility of incorporation. The same indications exist in cases involving only diaphyseal substitution where osteogenetic invasion of the graft can occur from both ends. In all the other cases, they recommend either resection arthrodesis or prosthetic replacement.