Interpretation and Natural History of Asymmetric Skin Folds in Infants With Developmental Dysplasia of the Hip.

The association between asymmetric skin folds (ASFs) of the gluteal, groin, or thigh regions and ipsilateral developmental dysplasia of the hip (DDH) has not been elucidated yet. Why are ASFs formed in some infants with DDH? Do DDH-associated ASFs persist during childhood and adulthood? Is it possible for ASFs to emerge without DDH pathology? Three cases of acute and chronic hip pathology in adults are presented in an attempt to explain the formation and the natural history of ASFs in infants with DDH. It is suggested that ASFs are formed when the excess soft tissues of the thigh shrink over a short femur.

Patellar Dislocation: Workup and Decision-Making.

Acute patellar dislocation (PD) is usually a problem of adolescents and young adults. In most cases, it is a sports-related injury. It is the result of an indirect force on the knee joint, which leads to valgus and external rotation of the tibia relative to the femur.

Primary Congenital Hallux Varus: A Step-Cut Surgical Approach.

Hallux varus is a rare deformity of the forefoot, which is characterized by medial deviation of the proximal phalanx of the great toe at the metatarsophalangeal joint. It is usually acquired, secondary to failed hallux valgus surgery, trauma, neurologic or rheumatologic disease. Rarely, this deformity may be congenital, either isolated, or in the context of various underlying congenital malformations of the foot, such as poly-syndactyly or longitudinal epiphyseal bracket, or part of generalized skeletal malformations.

Distal Tibia Epiphysiodesis After Saphenous Vein Catheterization During Treatment for Prematurity.

Extravasation injuries are frequent complications, especially in extremely preterm neonates treated in neonate intensive care units (NICU). Depending on the type of the extravasated substance, the duration, and the amount of the leak, extravasation may result in necrosis of the soft tissues adjacent to the leak, compartment syndrome, and limb amputation. However, in some cases, the results of extravasation may be evident years after NICU treatment.

Current Concepts on the Application, Pharmacokinetics and Complications of Antibiotic-Loaded Cement Spacers in the Treatment of Prosthetic Joint Infections.

Prosthetic joint infection (PJI) is a devastating complication of total joint replacement surgery. It affects about 2% of primary total joint replacements. Treatment aims at infection eradication and restoration of patient's mobility.

An Anatomic Single-Suture Trans-osseous Technique for the Repair of Acute Achilles Tendon Ruptures.

Several surgical methods for the treatment of acute Achilles tendon ruptures have been described. Whether open or percutaneous, these methods may be subdivided into two categories: all-soft-tissue procedures or procedures with stabilization of the Achilles tendon directly on the os calcaneum. The former comprise end-to-end suturing of the tendon stumps, the latter include additional stabilization of the sutures on the calcaneus either with bone anchors or by means of trans-osseous sutures.

Femoral Head-Neck Translation Ratio Is a Measurement of the True Deformity of Slipped Capital Femoral Epiphysis.

A new method to quantify proximal femoral head-neck deformity in slipped capital femoral epiphysis (SCFE) is presented. In SCFE the femoral head slips posteriorly and inferiorly relative to the femoral neck. The distance of the femoral head center from the femoral neck axis (center-axis distance, CAD) represents the severity of the post-slip deformity.

Genu Recurvatum After Prolonged Bracing for Drop-Foot in a Patient With History of Guillain-Barre Syndrome.

A case of unilateral genu recurvatum (GR) in a 15-year-old boy with a history of Guillain-Barre syndrome (GBS) and subsequent bilateral drop-foot is presented. Muscle imbalance of the lower limb and repetitive pressure from prolonged usage of an orthosis to deal with drop-foot may be the causative factors for early partial physeal arrest of his right proximal tibia. The result was a right GR and a shorter right lower limb.

Instability Testing for Congenital Hip Dislocation: Knee Extension Provokes Hip Dislocation.

The classic Ortolani and Barlow signs are routinely used to diagnose hip instability secondary to severe acetabular dysplasia in the newborn. However, eliciting a positive sign depends largely on the experience of the examiner and the subjective amount of manual pressure the examiner applies on the baby's hips. Furthermore, these signs do not give a clue for the selection of a maturation or immobilization device after reduction of an unstable hip: below-knee hip spica, above-knee hip spica or a Pavlik harness.

Transosseous Suture Fixation of Avulsion Fracture of the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint.

Acute traumatic avulsion or rupture of the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal (TMP) joint is a frequent sports-related injury. If not diagnosed and treated early, it may lead to chronic instability, pain, and loss of pinch and grip strength and possibly osteoarthritis. UCL insufficiency may be treated by various techniques, such as bone anchors, transosseous sutures with or without a pull-out button, tendon grafts, or with TMP joint fusion in neglected cases with arthrosis.

Causes of Delayed Diagnosis of Slipped Capital Femoral Epiphysis: The Importance of the Frog Lateral Pelvis Projection.

Delayed diagnosis and treatment is a universally reported problem that impairs the prognosis of slipped capital femoral epiphysis (SCFE). Quite frequently, a delayed diagnosis of SCFE is observed in spite of serial admissions and examinations of the limping adolescent. Why do health professionals globally fail to make a definitive diagnosis of SCFE during the first examination of the patient? A retrospective study of 36 adolescents treated for stable SCFE and two adolescents treated for unstable SCFE has been performed.

Factors Affecting Outcomes of Slipped Capital Femoral Epiphysis.

Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results.

Leg Length Discrepancy Due to Loss of Femoral Antecurvatum After Elastic Stable Intramedullary Nailing of Diaphyseal Fractures of the Femur in Children.

Limb length discrepancy (LLD) is a frequent complication after elastic stable intramedullary nailing (ESIN) of femoral shaft fractures in children. It is the result of either shortening or lengthening of the affected limb. A shorter limb is usually observed when there is no strict adherence to the main indication of the technique, which is a transverse or short oblique fracture of the diaphysis.

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method.

The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus. This anatomic structure is crucial for the stable anatomic reduction of a displaced extension type supracondylar fracture.

Isolated Avulsion Fracture of Patellar Attachment of Medial Patellotibial and Medial Patellomeniscal Ligaments in the Presence of Trochlear Dysplasia: An Indication for Acute Surgical Repair.

We present the case of a 13-year-old female athlete with acute traumatic lateral patellar dislocation. Patella reduced spontaneously with knee extension. Clinical examination revealed pain and tenderness at the middle/inferior part of the medial patellar border.

Identification of an Autosomal Dominant Mutation in the Gene Leading to Spondyloepiphyseal Dysplasia Congenita in a Greek Family.

A boy and his father with severe short stature, progressively evolving body asymmetry, and skeletal abnormalities are presented. A next-generation sequencing exome study was performed, and the patient was found heterozygous for the c.1609G>A (p.

Lateral spinal profile in school-screening referrals with and without late onset idiopathic scoliosis 10 degrees-20 degrees.

Introduction: The aim of this report is a) to study the lateral spinal profile, (LSP), in school-screening referrals with and without late onset idiopathic scoliosis of small curves 10 degrees - 20 degrees Cobb angle and b) to validate LSP's aetiological importance in idiopathic scoliosis pathobiomechanics.

Methods And Material: The spinal radiographs of 133 children, 47 boys and 86 girls with a mean age of 13.28 and 13.

Study of the rib cage deformity in children with 10 degrees-20 degrees of Cobb angle late onset idiopathic scoliosis, using rib-vertebra angles--aetiologic implications.

Unlabelled: The aim of the study is to compare the rib-vertebra angles (RVAs) between children with 10 degrees - 20 degrees of Cobb angle late onset idiopathic scoliosis (LOIS) and non-scoliotic children.

Materials And Method: The RVAs of 47 children, with mean age 12.4 years, who presented LOIS with a Cobb angle 10 degrees - 20 degrees, were studied.

The Double Rib Contour Sign (DRCS) in lateral spinal radiographs: aetiologic implications for scoliosis.

Unlabelled: All lateral spinal radiographs in idiopathic scoliosis show a DRC sign of the thoracic cage, a radiographic expression of the rib hump. The outline of the convex overlies the contour of the concave ribs. The aim of this study is to assess this DRC sign in children with and without Late Onset Idiopathic Scoliosis (LOIS) with 10 degrees -20 degrees Cobb angle, and to examine whether in scoliosis the deformity of the thorax or that of the spine develops first.

Menarche in scoliotic and nonscoliotic Mediterranean girls. Is there any relation between menarche and laterality of scoliotic curves?

Unlabelled: There is a controversy in the current literature concerning the age at menarche between scoliotic and nonscoliotic girls. The aim of this study is to elucidate this issue in the Mediterranean school aged girls.

Material And Methods: The menarche of 1,305 nonscoliotic girls (mean age 12,3 years, range 7,41 to 18,41 years, SD 2,5 years) and of 105 scoliotic girls (mean age 14.

Scoliosis and cavus foot. Is there a relationship? Study in referrals, with and without scoliosis, from school screening.

Background: The correlation of idiopathic scoliosis and cavus foot has been previously reported. This has been ascribed to possible lesions related to muscular imbalance influenced by the central nervous system. The aim of this study is the assessment of this correlation.