Surgical Treatment of Thumb-in-Palm Deformity: A Case Report.

CASE: A 13-year-old adolescent boy with spastic triplegia was referred to our institution with a thumb-in-palm deformity. An intramuscular slide of the flexor pollicis longus and augmentation of the weak abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis by tendon transfer were performed. Two years later, the result of the surgery was evaluated as excellent. CONCLUSION: There are several factors that will play a decisive role in the final outcome and effectiveness of hand surgery, such as the severity of the neuromuscular disorder, the extent of the deformity, the quality of voluntary muscle control, hand sensibility, and the age and intelligence of the patient.

Wrisberg variant of the lateral discoid meniscus in children: review of the literature and presentation of case series.

INTRODUCTION: The Wrisberg variant of the discoid lateral meniscus is a very rare disorder and is characterized by the hypermobility and instability of the meniscus caused by the absence of its posterior tibial attachment, with only its meniscofemoral junction (Wrisberg's ligament) maintained, and inserted in the posterior horn of the meniscus. As a result, the posterior horn of the lateral meniscus is mobile; often subluxing into the joint. MATERIALS AND METHODS: A total of eight skeletally immature patients with symptomatic Wrisberg variant of the discoid lateral meniscus were included in this study. Each knee was evaluated with MRI and arthroscopy. We graded unstable discoid menisci according to their discoid morphology (complete vs. incomplete), meniscal intra-substance degeneration, and the presence or absence of meniscal tears. All eight menisci were evaluated as degenerated with no meniscal tears. Five of them were evaluated as complete. Due to the severely degenerated meniscus, we considered it unnecessary to repair the detached posterior tibial ligament, so we performed a reshaping of the discoid meniscus, restoring a C-shape, excising the hypertrophied central part of the meniscus, and creating a posterior horn with a remaining rim of 6-8 mm. For evaluation of the knee function preoperatively and postoperatively we used the online International Knee Documentation Committee (IKDC) system. The purpose of this study is to emphasize the importance of MRI in identifying and revealing the unstable (Wrisberg variant) type of discoid meniscus in children. RESULTS: The mean patient age at the time of surgery was 8.25 ± 2.91 years (range 5-13 years). The average follow-up was 3.75 ± 0.46 years (range 3-4) years. The mean preoperative IKDC score was 22.37 ± 1.50 (range 21-25) points. The mean postoperative IKDC score was 80.50 ± 1.77 (range 79-84) points. CONCLUSIONS: MRI is a valuable tool in the evaluation of the shape, stability, and consistency of symptomatic discoid menisci. It is helpful for the detection of the unstable Wrisberg variant.

Surgical Treatment of Irreducible Dislocation of the Patellae in an 8-Year-Old Girl with Down Syndrome: A Case Report.

CONCLUSION: The purpose of this treatment was to correct this disorder and prevent disabling conditions in childhood and adulthood.

Split Transfer of Tibialis Posterior Tendon After Failed Tibialis Anterior Transfer for Recurrent Bilateral Clubfeet: A Case Report.

CASE: We describe the split transfer of tibialis posterior tendon to the tendon stump of tibialis anterior and distal end of peroneus brevis after a failed transfer of tibialis anterior to the lateral aspect of the foot for recurrent bilateral clubfeet at the age of 5 years. The purpose of this surgical technique was to restore the dynamic balance of foot inversion-eversion, during the gait cycle, by augmenting the muscular strength of peroneus brevis and tibialis anterior. The results of the 4-year follow-up were very encouraging. CONCLUSION: We recommend this technique for a failed tendon transfer of the tibialis anterior for recurrent clubfeet.

Bilateral Madelung Wrist Deformity in a 13-Year-Old Girl: Surgical Correction With the Taylor Spatial Frame External Fixation System.

Madelung deformity is a complex malformation of the wrist, due to growth disturbance in the volar and ulnar part of the distal radial physis. We report a bilateral idiopathic Madelung wrist deformity, in a 13-year-old girl, corrected surgically with the Taylor spatial frame external fixation system plus osteotomy. The Taylor spatial frame,a hexapod system of external fixation, has the ability, by distraction histogenesis, to simultaneously correct all components of this multiplanar three-dimensional wrist deformity, restoring gradually the distal radius morphology and radiocarpal alignment. Furthermore, the hexapod system, assisted with a web-based software program, allowed for, any time during the correction procedure, all proper modifications of the prescription needed, for the deformity correction. With this surgical technique, we achieved a full correction of the bilateral Madelung deformity and restored good function.

Late Repair, One Year After a Knee Twisting Injury, of a Missed Femoral Trochlea Osteochondral Fragment, With Bioabsorbable Nails, in a 14-Year-Old Boy.

The authors report a case of a late repair of a missed, large, osteochondral fracture of the femoral trochlea in a 14-year-old boy due to lateral patellar dislocation after a twisting injury of the knee a year ago. The late-1 year after the knee injury-imaging assessment of the patient regarding radiograph images, CT scan, and MRI was misleading, misinterpreted, and failed to reveal this osteochondral fracture. The free osteochondral fragment was detected during diagnostic arthroscopy. Open reduction and fixation of the osteochondral fragment with bioabsorbable pins were done, and healing was achieved within an acceptable time. The patient's clinical and imaging examination with knee MRI, a year after the surgical treatment, was highly satisfactory. Fixation with bioabsorbable pins showed to be a worthwhile option in this case. The technique used was straightforward, with excellent short- and long-term results. Bioabsorbable pins may be used to restore successfully even an old, large osteochondral fracture in the immature skeleton.

Arthroereisis for Symptomatic Flexible Flatfoot Deformity in Young Children: Radiological Assessment and Short-Term Follow-Up.

The purpose of this study is to recognize those young patients with symptomatic flexible flatfoot deformity who need treatment and to provide radiological evidence that arthroereisis is capable of relocating the talus properly over the calcaneus. We included 28 feet in 14 children who underwent subtalar arthroereisis in association with percutaneous triple-hemisection Achilles tendon lengthening. Selected for arthroereisis were children with symptomatic flexible flatfoot deformity who complained of foot and leg pain, had decreased endurance in sports activities and long walks, who did not respond to conservative treatment modalities for at least 6 months, and in whom at radiological assessment on stance position with the medial arch support orthosis the talonavicular joint lateral subluxation still remained, with Meary's angle in anteroposterior (A/P) and lateral view remaining increased. The mean age at surgery was 10.71 ± 1.58 (range 8 to 14) years. The minimum follow-up duration was 19 months, with mean follow-up duration of 35.14 ± 9.82 (range 19 to 60) months. For estimation of the efficacy of the surgical procedure, the American Orthopaedic Foot and Ankle Society (AFOAS) rating scale was used preoperatively and postoperatively in all patients. The mean preoperative AFOAS ankle-hind foot rating score was 65.14 ± 7.16 (range 58 to 75) points. The mean postoperative AFOAS score was 88.851 ± 5.61 (range 83 to 97) points and the 2-tailed p value <.0001. After arthroereisis surgical treatment, all AOFAS scores and all foot angles improved significantly, except the calcaneal inclination angle which improved slightly.