Unilateral genu valgum associated to vitamin D deficiency: A multidisciplinary approach in a patient followed from 3 to 21 years - A case report.

INTRODUCTION: Lower limb postural deformities are usually bilateral and in the majority of cases tend to spontaneous correction without any treatment. On the contrary, unilateral genu valgum is a rare deformity in children, it is frequently associated with systemic pathological conditions and require a specific treatment. PRESENTATION OF CASE: A three-year-old child affected by severe unilateral left genu valgum was followed by a multidisciplinary team. The initial treatment was medical, based on 10,000 IU of cholecalciferol every 2 months without any improvement after 6 months. Therefore, the patient was surgically treated by hemiepiphysiodesis of distal femur and proximal tibia with eight-plate obtaining a complete correction of the deformity in 10 months. Medical treatment continued for 4 years since the diagnosis. At follow-up, 18 years later, an excellent clinical result was observed. DISCUSSION: The association between unilateral genu valgum and vitamin D deficiency is extremely rare. In case of unilateral limb deformity, it is essential to investigate the aetiology to obtain a correct diagnosis and perform a specific multidisciplinary treatment. The goal of the management is to correct the deformity and avoid any recurrence. CONCLUSIONS: We believe that in unilateral genu valgum is always necessary a correct multidisciplinary diagnosis and treatment. The peculiarity of our case is the long-term follow-up and the absence of recurrence despite early surgical treatment. Further studies are necessary to better define the correlation between unilateral axial deformity and vitamin D deficiency.

Medial subtalar dislocation from a low-energy trauma. A case report and review of the literature.

INTRODUCTION: Subtalar dislocation is a rare injury characterized by a simultaneous dislocation of the talocalcaneal and talonavicular joints. The most common type is caused by high-energy trauma with medial dislocation of the foot. This injury is frequently associated with fractures, but isolated dislocations are also reported. CASE PRESENTATION: We report a rare case of medial subtalar dislocation secondary to low-energy injury in a 61-year-old woman. Following X-rays and CT scan, prompt closed reduction was performed under sedation and, after reduction, X-rays showed a good realignment of the foot. The CT scan revealed an occult non-displaced fracture of the posterior part of the talus. The patient was managed conservatively by a non-weight bearing cast for four weeks, followed by a rehabilitation program. At follow-up, six months later, we observed a good clinical and radiographic result. DISCUSSION: The reported case confirms that the mechanism of injury is an important factor in predicting the final result, since subtalar dislocations secondary to a high-energy trauma are often associated with significant complications. We believe, in agreement with other authors, that a low-energy trauma generally doesn't produce long-term morbidity. Prompt reduction is very important in order to minimize soft tissue and neurovascular complications, although a CT is recommended to identify occult fractures. CONCLUSION: Subtalar dislocations, caused by low energy trauma, if adequately reduced in the emergency room, generally heal with conservative treatment, reducing the risk of significant complications. However, since we report a single patient, further case analysis is needed to make solid conclusions.