21/231. Blount's disease: a lesser known cause of bowlegs mandating early differentiation from physiological bowing. We present a 16-month-old child, with progressively increasing bowing of legs, having a normal serum calcium, phosphorus and alkaline phosphatase level; lower limb radiographs revealed bilateral medial tibial metaphyseal beaking. Based on these findings, a diagnosis of Blount's disease (infantile tibia vara) was made and an orthotic management program was instituted for the child. ( info) |
22/231. osteochondrosis of the primary ossification center of the patella (Kohler's disease of the patella) report of three cases. radiography of three boys 5-6 years old with anterior knee pain revealed increased density and irregularity of the patellar ossification centers. A search of the literature suggested that it was osteochondrosis of the primary ossification center of the patella, named after Kohler. Continuing search also revealed that it might be a normal variant instead of an osteochondrosis. A short course of activity modification led to marked improvement in all. The patients were either asymptomatic or experienced minor symptoms 18-34 months after presentation. It was concluded that the process, either physiological or pathological, has a benign course and favorable prognosis. ( info) |
23/231. The Nathalie syndrome. A new hereditary syndrome. deafness, cataract, muscular atrophy, skeletal abnormalities, retardation of growth, underdeveloped secondary sexual characteristics, and electrocardiographic abnormalities are the features of a new, probably hereditary syndrome. case reports are presented. ( info) |
24/231. Lesions of the trochlea tali. Osteochondral fractures and osteochondritis dissecans of the trochlea tali. Osteochondral fracture of the trochlea tali, which can result in osteochondritis dissecans of this trochlea, is often not recognized as such and therefore not adequately treated. The nonrecognition is mainly due to the fact that the fracture can either remain asymptomatic or produce symptoms of inversion-distortion; to a lesser degree it is also due to the fact that the lesion is not identified in the radiograph. In view of these facts it would seem necessary in all cases of distorsion to make an X-ray examination of the ankle, ascertaining that the trochlea tali is adequately visualized. Unless the symptoms abate within a week, radiological examination should be repeated. The same applies to patients whose initial recovery is followed by a relapse of symptoms. Surgical treatment of choice for osteochondral fractures. The symptomatology and therapeutic results in 46 osteochondral fractures studied were in agreement with data from the literature. Therapeutic results can be improved by earlier diagnosis and more adequate treatment of the condition. ( info) |
25/231. A new surgical technique for treating bilateral Freiberg disease. Freiberg disease is relatively rare and difficult to treat satisfactorily. We describe a new surgical technique of osteochondral plug transplantation for late-stage Freiberg disease that may restore normal function to the metatarsophalangeal joint. In the present series, we performed osteochondral plug transplantation to treat a stage IV lesion, according to Smillie's classification, by harvesting an osteochondral plug from the non-weight-bearing site on the upper lateral femoral condyle of the ipsilateral knee. We also treated a stage II lesion using retrograde drilling. One year after surgery, the patient had no pain when running and returned to full athletic activity. The clinical and morphologic results were excellent. Arthroscopic intervention produced good results in the early stages and osteochondral plug transplantation may be an excellent surgical procedure to restore normal function to the metatarsophalangeal joint in the later stages of Freiberg disease. ( info) |
26/231. osteochondrosis of the superior pole of the patella: two cases with histologic correlation. Two cases of osteochondrosis of the superior pole of the patella are reported with histologic findings. Both patients were young girls; one had mild cerebral palsy. Sixteen cases of this disorder have been documented but without histologic study. The histologic features of these two cases showed osteonecrosis with reparative changes. These findings support that this entity is similar to other osteochondroses of the quadriceps mechanism: Osgood-Schlatter disease and Sinding-Larsen-Johansson disease. ( info) |
27/231. Treatment of Kienbock's disease using a silicone rubber implant. Ten patients with Kienbock's disease treated by resection and replacement with a silicone rubber implant through a volar approach were reviewed after follow-up ranging from twenty-four to thirty months. The results were good in seven and unsatisfactory in three: two patients had volar dislocation of the implant and one, median-nerve paresthesias of unexplained origin. ( info) |
28/231. Intertrochanteric osteotomy in the treatment of Perthes' disease. Intertrochanteric osteotomy has been carried out in 34 children with Perthes' disease. Five weeks after the operation the patients were allowed to move about freely. The average postoperative follow-up period was 27 months. At that time the results seemed to be at least as good as those of Thomas' splint therapy. The varus-derotation osteotomy performed in the initial stage accelerated the process of reossification and seemed to prevent subluxation. According to our findings it is worthwhile correcting the subluxation even in cases with irreversible changes. ( info) |
29/231. Bilateral Kohler's disease in identical twins. Kohler's disease is an uncommon idiopathic osteochondrosis of the tarsal navicular bone. The diagnosis is clinical and the natural history is benign. The treatment is symptomatic, including shoe supports when the symptoms are mild and initial cast immobilization for at least 8 weeks when the symptoms are more intense. The final clinical outcome is always favorable. This article reviews the development of bilateral Kohler's disease in identical twin brothers with simultaneous onset and parallel clinical course. Bilateral involvement in identical twins, to the authors' knowledge, has not been reported in the literature. Although this is a preliminary finding, it can imply that an unknown genetic predilection may exist and relate to the appearance of this rare disease. ( info) |
30/231. Osteochondritis of the navicular: a case report. Brailsford's disease and Kohler's disease are two conditions of uncertain etiology affecting the navicular in adults and children, respectively. Kohler's disease has been universally agreed to have an excellent outcome in all cases. There have been no recorded cases of a child with Kohler's disease having persistent clinical and radiological abnormalities into adulthood and no cases of patients with Brailsford's disease having had abnormalities in childhood. This case report presents a teenage patient with osteochondritis of the navicular bone with symptoms that persisted into skeletal maturity. ( info) |