1,720,965 research outputs found
Pubic osteolysis simulating a malignant lesion. A case report with long-term follow-up
No full textPubic osteolysis is a rare pathology characterized by a painful radiographic destructive changes in the pubic rami, pubis or pubic symphysis that often follows a post-traumatic event. The etiology is unclear but it is a benign lesion, frequently misinterpreted as malignant. We report a case of a 54-year-old woman with pubic osteolysis mimicking a malignant lesion, diagnosed after open bone biopsy, conservatively treated without any sequelae and followed-up 10 years after the end of treatment. Although in the majority of the reported cases, a previous trauma has been commonly referred, in our case the patient did not refer to any cause before the onset of clinical symptoms. Knowledge of this entity is important to avoid invasive diagnostic procedures, costly investigations or overtreatment
Lateral humeral condyle fractures: Diagnosis, classifcation, management and complications
No full textintroduction: the pediatric population. the mean age of patients with these fractures is 6 years. in the majority of the cases, the diagnosis is based on clinical and radiographic examination. the most recent classifcation divides these fractures according to degree of displacement and stability.evidence acquisition: a literature search was performed using pubmed and scopus database, until June 2020. Inclusion criteria were studies regarding lateral humeral condyle fractures in pediatric patients. case reports were excluded. EVIDENCE SYNTHESIS: most of the studies in literature are retrospective with contrasting opinions and conclusions on diagnosis, classifcation and management. conclusion: regarding the diagnosis and classifcation, the stability of the fracture remains in some cases diffcult to ascertain and MRI can be helpful in identifying the integrity of the articular cartilage and hence fracture stability. displaced or unstable fractures are preferably treated by closed reduction and percutaneous pinning, while fractures that have rotation of the condylar fragment need to be treated surgically. ORIF can be performed by using different approaches, and the methods of fxation are K-wires or screws. the main factors associated with long-term results are quality of reduction and timing of treatment. the most serious complications are cubitus varus, nonunion, AVN of the condylar fragment and ulnar nerve palsy
Heterotopic ossification around the lesser trochanter of the femur simulating a malignant lesion. A case report with long-term follow-up and revision of literature
No full textWe report the case of a 28-year-old female who complained of groin pain and restricted range of motion of the hip for the previous two months. A plain radiograph, CT scan and MRI of the pelvis showed a bone mass of uncertain origin around the lesser trochanter, simulating malignancy. An open biopsy was performed to obtain a correct diagnosis. The histological examination excluded a malignant lesion. Two months later, the mass was surgically excised and at follow-up, 9 years after surgery, the patient was completely asymptomatic, without any radiographic sign of recurrence. This is a rare case of heterotopic ossification of the proximal part of the femur, that appeared without any significant trauma or other predisposing risk factors; because the lesion led us to suspect a malignant disease, an open biopsy was needed to make the diagnosis. From an accurate review of the literature, heterotopic ossifications mimicking a malignant lesion that appeared without any predisposing factors are extremely rare
Surgical correction of valgus deformities of the knee in Polyostotic Fibrous Dysplasia
No full textcoxa vara and shepherd’s crook deformity represent the most common femoral deformities in patients affected by polyostotic fibrous dysplasia (PFD) and mccune albright syndrome (MAS). the tibia is also commonly affected, with antero-medial bowing and valgus deformity. surgical treatment of these deformities are technically demanding and, in most cases, intramedullary nails are the preferred method to stabilize corrective osteotomies. genu valgus may also be present, as a residual defect after the surgical correction of the aforementioned deformities. the aim of our study was to report the outcomes obtained in five patients with PFD or MAS operated on for complex deformities of the lower limbs with an associated residual genu valgum greater than 15°. It was surgically treated by distal femoral or proximal tibial osteotomy stabilized with a screw plate. the osteotomy was performed distal to the intramedullary nail in femurs, while it was performed after removing the intramedullary nail in the proximal metaphysis of the tibia. In latter cases, the intramedullary device was reinserted at least 6 months after surgery. at follow-up, the femoro-tibial angle was corrected in all cases and the patients were satisfied with the final result. two patients showed mild limping, unrelated to the alignment of the knee. In our opinion, residual valgus deformities of the lower limb greater than 15 degrees should be corrected to improve function and cosmetic appearance of these patients. the osteotomy of the distal femur or of the proximal tibia stabilized by a screw-plate represent the treatment of choice for the correction of these deformities
Surgical treatment of primary trapezio-metacarpal osteoarthritis by trapeziectomy and ligament reconstruction without tendon interposition. Long-term results of 50 cases
No full textPrimary trapezio-metacarpal osteoarthritis can be painful and disabling. Surgical treatment is used when conservative treatment, such as splinting or oral analgesics, fails. The purpose of this study was to report the long-term outcomes obtained in 40 patients (50 thumbs) surgically treated for thumb osteoarthritis by trapeziectomy and ligament reconstruction without tendon interposition
The role of musculoskeletal aspects in the early diagnosis of Marfan Syndrome in children
No full textbackground: diagnosis of marfan syndrome (MS) in children is difficult because the ghent criteria commonly used in adults are unreliable in pediatric populations. the aim of our study was to investigate the role of musculoskeletal aspects in the early diagnosis of MS by analyzing a pediatric cohort of patients. methods: we investigated 40 children with MS admitted at the referral center for diagnosis of rare diseases of our hospital. for this study, all children underwent evaluation by an orthopedic, a cardiac surgeon, an ophthalmologist, a geneticist and a pediatrician. a blood test was also performed for genetic assessment to evaluate the presence of FBN1 pathogenic variant. results: skeletal abnormalities were observed in all children. the wrist and thumb signs were present in isolated form or in association in 72.5% of cases, pectus carinatum or excavatum, and chest asymmetry in 20%, foot deformities in 27.5%, reduced upper to lower segment ratio in 5%, scoliosis or kyphosis in 7.5% of patients. conclusions: diagnosis of MS remains difficult in the pediatric population because the majority of clinical features are “age-dependent.” therefore, the ghent criteria might be not reliable, especially in younger children. however, the typical musculoskeletal aspects may represent the first alarm bell to guide children towards an early diagnosis
Lower limb lengthening over an intramedullary nail: A long-term follow-up study of 28 cases
No full textLimb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley's technique, in 28 patients, followed up after a mean period of 8 years
Surgical Treatment of Severe Idiopathic Flexible Flatfoot by Evans-Mosca Technique in Adolescent Patients: A Long-Term Follow-Up Study
Full text linkflexible idiopathic flatfoot is very common in growing age and rarely causes pain or disability. surgery is indicated only in severe symptomatic cases that are resistant to conservative treatment, and numerous surgical procedures have been proposed. lateral column calcaneal lengthening as described by evans and modified by mosca is a widely used surgical technique for the correction of severe symptomatic flexible flatfoot. In the present study, we report the long-term clinical and radiographic results in 14 adolescent patients (mean age: 12.8 years) affected by severe symptomatic flexible flatfoot, surgically treated by Evans-mosca procedure, for a total of 26 treated feet (12 cases bilateral and 2 unilateral). In all cases, surgery was indicated for the presence of significant symptoms resistant to nonsurgical management. clinical evaluation was made according to the american orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale, the foot and ankle disability Index (FADI) score, and yoo et al.'s criteria. radiographic evaluation was made using anteroposterior and lateral weight-bearing radiographs of the feet to evaluate meary's angle and costa-bertani's angle and to evaluate possible osteoarthritic changes in the midtarsal joints. at follow-up (mean: 7 years and 7 months), we observed a satisfactory result in all patients. the mean average score of the AOFAS ankle-hindfoot scale improved from 60.03 points to 95.26; the mean FADI score improved from 71.41 to 97.44; and according to Yoo et al.'s criteria, the average clinical outcome score was 10.96. at radiographic examination, nonunion of the calcaneal osteotomy was never observed. meary's angle improved from an average preoperative value of 25° to 1.38° at follow-up; costa-bertani's angle improved from an average preoperative value of 154.2° to 130.9° at follow-up. In no case, significant radiographic signs of midtarsal joint arthritis were observed. according to our results, we believe that evans-mosca technique is a valid option of surgical treatment for severe idiopathic flexible flatfoot and allows a satisfactory correction of the deformity with a low rate of complications
Anterior tibial tendon transfer for treatment of recurrent congenital clubfoot initially treated according to Ponseti method. Update and systematic review of literature
No full textsummary
background. congenital clubfoot has a tendency to recur regardless the type of treatment; recurrences generally occur after a complete correction of the deformity. and according to ponseti method, since extensive surgery has a high rate of poor results. the aim of our study was to analyze a series of papers, recently published, to evaluate the effectiveness of TATT for treatment of recurrent congenital clubfoot initially treated according to ponseti method.
methods. a literature search on the topic was performed by searching the databases medline (pubmed) and cochrane Library, to select only articles from the recent literature (January 2000 to January 2021). the articles were screened for the presence of the following inclusion criteria: patients affected by recurrent congenital clubfoot originally managed by ponseti method and treated by anterior tibial tendon transfer. all the patients affected by non-idiopathic congenital clubfoot and by residual deformities or neglected deformities were excluded.
results. the initial search produced 123 studies from medline database and 22 studies from cochrane library database. after detailed evaluation based on inclusion and exclusion criteria, articles were screened and only 11 studies fulfilled the eligibility criteria of our study. all the selected articles were published from 2006 to 2020 and they included overall 331 patients (481 clubfeet).
conclusions. we believe that TATT is an effective surgical procedure to treat recurrent clubfeet initially treated by ponseti method, independent of the type of surgical technique. a second recurrence is absolutely not common, however it is more frequent when TATT is performed in younger patients. TATT seems to be effective also in late relapse, although in some cases an associated surgical procedure is necessary
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