Satisfactory outcomes of post-operative subtalar extra-articular arthroereisis in juvenile flexible flat foot.

OBJECTIVES: To analyze the surgical outcomes of subtalar extra-articular arthroereisis and the patient/parent satisfaction regarding the foot's shape, foot pain, ability to walk, ability to jump, and shoe wear. METHODS: Our retrospective cross-sectional study was carried out through an online-based questionnaire to assess patient satisfaction postoperatively at 3 hospitals (King Khalid University Hospital, Sultan bin Abdulaziz Humanitarian City, and Dallah Hospital, Riyadh, Saudi Arabia) between the years 2014-2021. RESULTS: A total of 65 patients participated in our study. Approximately 86.1% of them had the operation bilaterally. The most important aspects where patients noticed the most improvement were the foot's shape (90.8%), pain (81.5%), and ability to walk (76.9%). CONCLUSION: Several studies have been carried out highlighting the surgical technique and complications of the procedure. However, a limited number of studies have been carried out to assess patient satisfaction with the procedure, especially in Saudi Arabia, as the procedure is considered relatively new in the region with insufficient data regarding it. Therefore, this study is considered one of the few articles regarding subtalar extra-articular arthroereisis in the region.

Open Reduction at 15 Months of Left Hip Dislocation in a Male Infant Diagnosed with Arthrogryposis.

BACKGROUND Arthrogryposis is a congenital condition of multiple contractures of joints associated with hip dislocation. The outcome of open reduction of hip dislocation in arthrogryposis patients is debatable. Open reduction of arthrogryposis is challenging for shallow acetabulum and extensive adhesions and fibrosis. For this reason, a careful extensive release must be carried out to achieve the open reduction of the hip in arthrogryposis patients. The literature lacks surgical recommendations for open reduction of the hip in arthrogryposis patients and how to deal with cases of the extruded bone segment during open reduction. CASE REPORT The patient presented in the first few weeks of life with bilateral clubfoot and left hip dislocation. Clinical diagnosis of arthrogryposis was made after referral to a genetics specialist. The hip was clinically irreducible. The patient underwent open reduction and femoral shortening using the Smith Peterson approach at the age of 15 months, with accidental extrusion of the proximal femur, which was retained immediately. The clinical outcome showed a painless, good range of motion. Radiographically, features of avascular necrosis and healed osteotomy site were evident. CONCLUSIONS A difficult hip reduction was expected in this arthrogryposis patient, which required careful dissection of surrounding fibrosis and appropriate femoral shortening. Careful dissection should be carried out during open reduction to avoid jeopardization of femoral head vascularity or even complete devitalization of the proximal femur.

Targeted Minimally Invasive Percutaneous Posteromedial Release of Residual Clubfoot in Myelomeningocele Patients: A Report of Two Cases.

Congenital talipes equinovarus (CTEV) is commonly associated with myelomeningocele (MMC). It is thought to be a mixture of intrauterine development and a result of an imbalance in muscular innervation. Conservative management has been explored for those cases, but most resulted in recurrence. In this study, we report two cases where targeted minimally invasive percutaneous posteromedial release of residual clubfoot was done using an 18-gauge needle and a small incision for the cuboid osteotomy. In both cases, we achieved plantigrade shoeable/braceable feet. Both cases are still followed in our clinic. They require further follow-up to assess their long-term outcomes.

Bilateral trochlear avascular necrosis: A case report and brief review of the literature.

INTRODUCTION AND IMPORTANCE: Trochlear AVN is a very rare entity with only a limited number of cases being reported. CASE PRESENTATION: Our case is interesting as it presents a case of an incidentally found bilateral trochlear AVN in a 12 year-old child when he presented with an undisplaced right supracondylar fracture. CLINICAL DISCUSSION: It is highly likely that an unknown underlying predisposing factor, possibly recurrent microtrauma, was responsible for the bilateral occurrence. CONCLUSION: We recommend further research to identify other etiological and predisposing factors, as the etiological factors still remain unclear, despite the available literature.