Diagnosis and treatment of congenital deformities of the musculoskeletal system in the newborn and the infant.
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Arthrogryposis↗
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Results for “Toe Joint”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Compression clamp for arthrodesis of first metatarso-phalangeal joint.
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Arthrodesis↗
Submandibular synovial sarcoma with t(X;18) and synovial sarcoma of the toe with additional cytogenetic abnormalities: presentation of two cases and review of the literature.
We report cytogenetic findings from fine-needle aspiration samples of two synovial sarcoma patients. The cases are of interest because (1) one case is of a rare site (submandibular region) of the head and neck, and (2) the other is a patient with synovial sarcoma of the toe showing additional cytogenetic abnormalities along with t(X;18). The literature of this tumor is reviewed.
Adult↗
Distally based dorsalis pedis island flap for a distal lateral electric burn of the big toe.
Reconstruction of the small defects in the distal portion of the foot has always represented a difficult problem. A case of a young man with a deep electric burn of the distal lateral side of the big toe successfully treated with a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery (FDMA) is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed 3 weeks later. Advantages; limits and anatomical consideration regarding the viability of the flap are also discussed.
Adult↗
Effect of Vernonia cinerea Less flower extract in adjuvant-induced arthritis.
1. The anti-inflammatory effect of an alcoholic extract from the flower of Vernonia cinerea (Asteraceae; Less) was tested in adjuvant arthritic rats. 2. Changes in paw volume, body and tissue weights and serum and tissue enzyme activities of ALT, AST, ACP and cathepsin-D in adjuvant rats were reversed by oral administration of 100 mg/kg body weight (BW) of the flower extract. 3. The extract also reversed the major histopathological changes in the hindpaws of the arthritic rats. 4. Phytochemical studies revealed the presence of alkaloids, saponins, steroids and flavonoids. 5. It is concluded that the extract contains as yet unidentified anti-inflammatory principle(s).
Alanine Transaminase↗
Effect of immobilization, immediate mobilization, and delayed mobilization on the resistance to digital flexion using a tendon injury model.
This study employed a tendon injury model in chickens to determine the effect of immobilization, immediate mobilization, and delayed mobilization on the energy required to fully flex the digit following surgical trauma to the tendon, as determined by measurement of the work of flexion (WOF). The immobilized group showed no increased WOF at 3 days compared to the zero time control values, followed by significant increased WOF at 1 week (36%), 2 weeks (41%), and 3 weeks (63%). The immediate mobilization tendons showed an initial 36% rise in the work of flexion at 3 days, which increased to 40% at 1 week, and then decreased to baseline control values by 3 weeks. Delaying the period of mobilization until 5 days was not shown to significantly lower the peak WOF value at 1 week, but delaying the period of mobilization until 3 days lowered the peak WOF value at 1 week dramatically to 13%; both the 3- and 5-day delayed-mobilization groups returned to baseline WOF values by 3 weeks. From these data, it can be assumed that there is an early increase in the work necessary for flexion of the injured operated digit and tendon that is present in the immediately mobilized tendons at 3 days and persists to 1 week and that does not appear until 1 week in the immobilized tendons; this rise in WOF can be blunted by delaying the institution of mobilization.
Animals↗
Flexor tendon-pulley interaction after annular pulley reconstruction: a biomechanical study in a dog model in vivo.
The excursion resistance between the canine flexor digitorum profundus tendon and A2 pulley was compared after pulley reconstruction using tendon grafts of either intrasynovial or extrasynovial origin at 10 days, 3 weeks, and 6 weeks after surgery. The changes over time in the underlying flexor digitorum profundus tendon after pulley reconstruction were also evaluated. The excursion resistance for both types of pulley reconstruction was significantly greater than that of the control group at all time periods. The excursion resistance of the extrasynovial tendon graft reconstruction was greater than that of intrasynovial pulley reconstruction at all time periods. In conclusion, pulley reconstruction with intrasynovial tendon grafts may facilitate tendon gliding after surgery.
Animals↗
Clinical presentation of congenital convex pes valgus.
Congenital convex pes valgus, frequently termed vertical talus in past descriptions, is a malformed foot that requires early diagnosis and treatment. A brief review of clinical features and a case presentation are provided to enhance the understanding of this complex deformity. A successful treatment regimen for infants and children is described, involving manipulation and early surgical correction.
Diagnosis, Differential↗
Failure of synovial fluid to cushion.
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Animals↗
Lesser digital fusion with a cannulated screw.
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Arthrodesis↗
Pediatric longitudinal epiphyseal bracket: Review and case presentation.
The longitudinal epiphyseal bracket is a rare deformity affecting the long and short bones of the hands and feet, creating an aberration in growth. The deformity is present in 2% to 14% of congenital hand and foot deformities, with 11% of all cases found in the great toe. Ultrasound may then be used to confirm the diagnosis. Radiographs usually show the presence of a bracket epiphysis once there is some ossification, but until then, the radiographs can appear normal. With the use of ultrasound, a suspected preossified bracket can be visualized and can establish the diagnosis. The purpose of this article is to present such a case with a preossified epiphyseal bracket of the great toe. The child presented initially with unremarkable x-rays, but the diagnosis was made with clinical suspicion and use of ultrasound. After surgical resection of the brackets, there was progressive improvement in the short-term follow-up. Long-term follow-up is essential until skeletal maturity, and, if the deformity persists, further surgical care may need to be implemented.
Child, Preschool↗
[Trigger hallux--a rare cause of pain at the inner malleolus].
Characteristic for a trigger-hallux is a thickening of the m. flexor hallucis longus tendon combined with partial rupture of the central fibers proximal to the tarsal tunnel. Division of the retinaculum flexorum leads to free tendon movement and prevents further tendon degeneration. The course of an 11-years old girl is reported. An effective treatment is established by a simple surgical procedure.
Ankle↗
Systemic zoledronate precoating of a bone graft reduces bone resorption during remodeling.
BACKGROUND: Cartilage degeneration often occurs after osteosynthesis of a devascularized intermediary fragment in a joint fracture, in mosaicplasty or in whole-joint toe-to-finger transplantation. Hypothetically, the degeneration is secondary to a collapse of the transferred subchondral bone as it remodels during high mechanical load. Bisphosphonates are used to reduce resorption of necrotic bone. We tested a systemic pretreatment before harvesting the graft in order to protect the bone and cartilage against collapse and secondary arthrosis. METHODS: Rats were given one zoledronate injection and bone grafts were harvested. The grafts were frozen, thawed and placed into bone chambers, and implanted into another batch of rats. Graft resorption and new bone formation was measured by histomorphometric analysis and compared with untreated grafts. RESULTS: In the remodeled area of the controls, the graft was almost totally resorbed and replaced by bone marrow. In the zoledronate-treated specimens, the graft remained and the graft trabeculas were lined with new bone. By histomorphometry, the total amount of bone (graft plus new bone) within the remodeled area was 16% in the zoledronate-treated grafts and 5% in the controls (p = 0.003). INTERPRETATION: A bone graft can be pretreated with bisphosphonate and remain protected against resorption once implanted again.
Animals↗
Biomechanical walking pattern changes in the fit and healthy elderly.
A descriptive study of the biomechanical variables of the walking patterns of the fit and healthy elderly compared with those of young adults revealed several significant differences. The walking patterns of 15 elderly subjects, selected for their active life style and screened for any gait- or balance-related pathological conditions, were analyzed. Kinematic and kinetic data for a minimum of 10 repeat walking trials were collected using a video digitizing system and a force platform. Basic kinematic analyses and an inverse dynamics model yielded data based on the following variables: temporal and cadence measures, heal and toe trajectories, joint kinematics, joint moments of force, and joint mechanical power generation and absorption. Significant differences between these elderly subjects and a database of young adults revealed the following: the same cadence but a shorter step length, an increased double-support stance period, decreased push-off power, a more flat-footed landing, and a reduction in their "index of dynamic balance." All of these differences, except reduction in index of dynamic balance, indicate adaptation by the elderly toward a safer, more stable gait pattern. The reduction in index of dynamic balance suggests deterioration in the efficiency of the balance control system during gait. Because of these significant differences attributable to age alone, it is apparent that a separate gait database is needed in order to pinpoint falling disorders of the elderly.
Adult↗
Radiographic validation of the Manchester scale for the classification of hallux valgus deformity.
OBJECTIVES: Hallux valgus is a common orthopaedic condition affecting elderly people. Grading the severity of the condition commonly involves obtaining measurements from radiographs, which may not be feasible or necessary in some clinical or research settings. Recently, a non-invasive clinical assessment tool (the Manchester scale), consisting of four standardized photographs, has been developed; however, its validity has not yet been determined. Therefore, the objective of this study was to determine the validity of this tool by correlating Manchester scale scores with hallux valgus measurements obtained from radiographs. METHODS: Weight-bearing dorsoplantar foot radiographs were obtained from 95 subjects (31 men and 64 women) aged 62-94 yr (mean 78.6, s.d. 6.5), and measurements of the hallux abductus angle, intermetatarsal angle and hallux interphalangeal adbuctus angle were performed. These measurements were then correlated with the Manchester scale scores (none, mild, moderate or severe). RESULTS: The Manchester scale score was highly correlated with hallux abductus angle (Spearman's rho = 0.73, P<0.01) and moderately associated with intermetatarsal angle (rho = 0.49, P<0.01) measurements obtained from radiographs. Analysis of variance revealed significant differences in mean hallux abductus angles [F3 = 119.99, P<0.001] and intermetatarsal angles [F3 =29.56, P<0.001] between the four Manchester scale categories. CONCLUSIONS: These findings indicate that the Manchester scale provides a valid representation of the degree of hallux valgus deformity determined from radiographic measurement of hallux abductus angle and intermetatarsal angle. We therefore recommend the use of this instrument as a simple, non-invasive screening tool for clinical and research purposes.
Aged↗
Peri-articular reactions to microscopic erosion of silicone-polymer implants. Light- and scanning electron-microscopic studies with energy-dispersive x-ray analysis.
Two patients are described who underwent implantation of silicone-polymer prostheses: one for an arthroplasty of the left great toe after a bunionectomy, and another for replacement of fractured trapezoid bone of the left wrist. Each patient developed unexplained severe pain at the sites of surgery at 3 and 7 months postoperatively. On removal of the implants and adjacent tissues, there was a microscopic foreign-body reaction to amorphous material in the subsynovial connective tissue. Although both prostheses were grossly intact, scanning electron microscopy revealed multiple erosions on their surfaces. Energy-dispersive x-ray analysis of foreign material in the paraffin-embedded sections revealed a peak for silicon. These two cases indicate that clinically significant pathological reaction may occur as early as 3 months after silicone-polymer implantation and that energy-dispersive x-ray analysis of excised tissue is a useful and specific diagnostic procedure.
Adult↗
End result study of Stone bunionectomies.
The Stone bunionectomy is an oblique resection of the metatarsal head designed to preserve the weight-bearing margin of the metatarsal shaft. In 132 patients treated by the Stone operation, only 77 per cent were satisfied with the overall results and 19 per cent had persistent pain. In addition, only 69 per cent were considered by the authors to have had an excellent result. These results do not compare favorably with those reported for the Keller procedure. Consequently, the Stone bunionectomy is not recommended.
Hallux Valgus↗