11/74. Where there's hope. A young patient's account of her preoperative and postoperative experiences is recalled. ( info) |
12/74. 'Ostoesynthesis' of a symptomatic bipartite medial cuneiform. Bipartition of the medial cuneiform is uncommon and often not recognized on plain radiographs. It is usually asymptomatic and rarely, if ever, requires surgery. Injury to the synchondrosis of a bipartite medial cuneiform is rare and has, to our knowledge, been reported only once. We describe such a case with chronic disabling midfoot pain after remote trauma. ( info) |
13/74. Myomectomy during the first trimester associated with fetal limb anomalies and hydrocephalus in a twin pregnancy. OBJECTIVES: To present the complications of a twin pregnancy after first trimester myomectomy and to discuss the possible etiologic relationship. CASE REPORT: A 44-year-old primigravida with a dichorionic-diamniotic twin pregnancy underwent myomectomy in another hospital at 12 weeks' gestational age. At 28 weeks the patient was referred to our unit because of ventriculomegaly and limb anomalies in the second twin. The patient underwent a Caesarean section at 37 weeks of gestation delivering twin A, a healthy female weighing 3235 g and twin B, a female weighing 2810 g with hydrocephalus and limb anomalies (clubfeet and hypoplasia of the nails and terminal phalanges). The placenta from twin A was normal, but in the placenta of twin B haemorrhage, thrombosis and infarction were noted. CONCLUSIONS: Despite several reports of myomectomy in pregnancy without any problems for mother and fetus, the authors believe that myomectomy - especially in the first trimester - may be associated with the type of problems observed in the present case. The pathophysiological relationship between placental trauma and haemodynamic alterations as a possible cause of the malformations in twin B is discussed. ( info) |
14/74. Lethal hydrops fetalis due to congenital dyserythropoietic anemia in a newborn: association of a new skeletal abnormality. Congenital dyserythropoietic anemias (CDAs) are a group of hereditary refractory anemias characterized by ineffective erythropoiesis, typical morphological abnormalities of erythroblasts, a low or no reticulocyte response, hyperbilirubinemia, and splenomegaly. A massive hydropic newborn born with a very severe anemia (Hb 4.8 g/dL), diffuse edema, hepatosplenomegaly, ascites, pulmonary edema and respiratory distress, and shortness and hallux varus deformity of the great toe of the right foot was diagnosed to have congenital dyserythropoietic anemia on the basis of the hematological (macrocytosis, anisopoikilocytosis, fragmented red cells and erythroblastosis in the peripheral blood, and erythroid hyperplasia with erythroblastosis and erythroblasts with double nuclei and thin chromatin bridges connecting these nuclei in the bone marrow) and serological (negative acidified serum lysis test and no agglutination with anti-i antibodies) findings. In this article the seventh case of neonatal congenital dyserythropoietic anemia presenting with a very severe (lethal) form of hydrops fetalis and a new (hallux varus) deformity of the great toe of the right foot is presented. Congenital dyserythropoietic anemia should be considered in the differential diagnosis of hydrops fetalis presenting with a very severe anemia and a skeletal abnormality of the great toe. ( info) |
15/74. Symptomatic bipartite medial cuneiform in an adult athlete: a case report. We present the case of a 32-year-old female marathon runner with a symptomatic bipartite medial cuneiform. The bipartite articulation was best visualized on a 30 degress external oblique radiograph of the foot. Surgical exploration revealed a noncartilaginous articulation between the two osseous segments. The smaller medial segment was excised. Postoperatively the patient's symptoms resolved, and at one-year follow-up she remains asymptomatic and has returned to competitive running. This case demonstrates that surgical excision is indicated for a symptomatic bipartite medial cuneiform that fails to respond to nonoperative measures. ( info) |
16/74. Unilateral split foot, torticollis, congenital heart defect and hydrocephaly: a new syndrome? We report a patient showing unilateral split foot together with unusual malformations. ( info) |
17/74. One pair must last a lifetime. Misshaped feet. This article is the fifth in this series examining issues in foot care. This month the authors outline care issues regarding misshaped feet. ( info) |
18/74. Retrograde-flow medial plantar island flap reconstruction of distal forefoot, toe, and webspace defects. Plantar forefoot defects have been reconstructed using a wide variety of techniques, including skin grafts, local flaps, and free tissue transfer. The distally based, retrograde-flow medial plantar island flap provides coverage with durable plantar skin from the nonweight-bearing instep area to reconstruct defects at the metatarsal heads. This technique requires careful flap dissection, and the anterior reach of the flap is limited by its pedicle length and vascular pivot point location. The authors describe two cases using this flap for reconstruction of tumor resection defects (5 x 6 cm and 5 x 8 cm) involving the distal forefoot, toes, and webspaces. One case required venous supercharging of a congested flap with an interpositional vein graft. Technical aspects of the design, elevation, and inset of the flap that enhance its versatility and reliability are presented. The reverse-flow medial plantar fasciocutaneous island flap should be considered an option for forefoot defects that extend anteriorly onto the metatarsal heads, including defects involving the toes and webspaces. ( info) |
19/74. Extensor hallucis longus tendon rupture repair using a fascia lata allograft. The authors present a case of a traumatic extensor hallucis longus tendon rupture sustained 2 days after hallux valgus and hammer toe correction. The ruptured tendon, separated by a 6-cm defect, was repaired using a fascia lata allograft. This case demonstrates a serious complication of a commonly performed procedure and a salvage technique useful for dealing with large tendon defects. ( info) |
20/74. Split cord malformation in two sisters. Split cord malformations (SCMs) are uncommon congenital spinal anomalies and are seen mostly in females. SCMs in siblings are extremely rare. We report two sisters with SCM. These 10- and 8-year-old girls were the first and second children, respectively, of nonconsanguineous parents. Both sisters had a hypertrichosis and pes cavus deformity. The first child had a type I SCM and the second a type II SCM. They had additional spinal lesions, with tethering of the spinal cord. They were operated on and showed an uneventful postoperative course. All reported siblings with SCM have been female. The present data are not sufficient to account for the sex predilection. Therefore, further data and knowledge are needed. ( info) |