Bilateral coexistent calcaneonavicular and talocalcaneal tarsal coalition: a case report.

Tarsal coalition refers to a union of two or more tarsal bones. The union may be fibrous, cartilaginous, or bony. The most common sites of tarsal coalition reported in the literature are the calcaneonavicular, the talocalcaneal, and, less commonly, the talonavicular areas. Bilateral coexistent multiple tarsal coalitions are a rare occurrence. The authors present a case report of a 17-year-old boy with bilateral coexistent calcaneonavicular and talonavicular bars. The diagnosis was established by radiographs and CT scanning. The patient was treated conservatively with immobilization of the foot in a below-knee walking plaster cast followed by the use of an orthosis with a lateral iron and a medial T strap. The patient was pain-free at 2-year follow-up.

Percutaneous Ethibloc injection in aneurysmal bone cysts.

OBJECTIVE: To investigate whether the injection of Ethibloc into aneurysmal bone cysts can be an effective treatment modality. DESIGN AND PATIENTS: Ethibloc is an alcoholic solution of zein (corn protein) which has thrombogenic and fibrogenic properties. Ten patients with aneurysmal bone cysts were treated with CT-guided percutaneous injection of Ethibloc into the cyst cavity. Ethibloc injection was the primary treatment in five patients. Four patients had recurrence following previous curettage and bone grafting and one patient had not responded to injection into the lesion of autologous iliac crest bone marrow aspirate. Three patients needed a second injection. The median follow-up was 27 (6-60) months. RESULTS AND CONCLUSION: Symptoms were relieved in all patients. At imaging, seven patients had resolution of the lesion and three had partial response at the most recent follow-up. Complications consisted of a local transitory inflammatory reaction in two patients and an aseptic abscess in one patient. This relatively simple, minimally invasive procedure makes an operation unnecessary by stopping the expansion of the cyst and inducing endosteal new bone formation. This technique may be used as the primary management of aneurysmal bone cysts excluding spinal lesions.

Serial changes in serum vitamin K1, triglyceride, cholesterol, osteocalcin and 25-hydroxyvitamin D3 in patients after hip replacement for fractured neck of femur or osteoarthritis.

Serum vitamin K1 concentrations were measured at presentation (just before surgery) and then at weekly intervals for 3 weeks in two groups of elderly patients requiring either hemiarthroplasty for fractured neck of femur (FON, n = 13) or total hip replacement for osteoarthritis of the hip (OA, n = 16). In comparison with healthy elderly volunteers (n = 25), serum vitamin K1 concentrations were significantly lower in both groups at presentation, and fell significantly within 24 h after surgery to concentrations approaching non-detectable, subsequently returning to pre-operative values within 3 weeks. Serum vitamin K1 tended to be lower in the fracture group both before and after operation, although calculation of a vitamin K1-triglyceride ratio reduced the apparent difference as triglyceride concentrations were lower in the fracture group. Osteocalcin concentrations were similar and fell significantly after operation in both groups, returning to pre-operative levels within 7 days. No differences in the two forms of osteocalcin (carboxylated and undercarboxylated) were observed either before or after operation in either group. 25-Hydroxyvitamin D3 concentrations were not significantly different between the two groups at any time. Vitamin K1 status may be lower than desirable in certain groups of the elderly population, and supplementation should be considered as prophylactic therapy.

Tibia recurvatum as a complication of Osgood-Schlatter's disease: a report of two cases.

Premature fusion of the anterior part of the upper tibial epiphyseal plate is a rare complication of Osgood-Schlatter's disease. The resulting deformity is both unsightly and difficult to treat. We report two further cases and highlight the need for regular screening for this rare complication of a common disease.

Etiology of Freiberg's disease: ? trauma.

Freiberg's disease is osteochondritis of the metatarsal head(s) commonly occurring in adolescent girls. The true etiology is unknown. The authors present a case precipitated by a form of folk dancing popular among British schoolgirls.

Galeazzi fractures in children.

We have reviewed 41 children under 15 years of age with a fracture of the radius and disruption of the inferior radio-ulnar joint. Despite the fact that the joint injury had not at first been recognised in 41% of cases and a variety of treatments had been used, the final results of conservative management were generally good. The more distal the radial fracture, the greater were the problems encountered.

Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy?

We report 53 patients who developed small bowel obstruction some time after the treatment of a primary malignant tumour. Previous treatment of the primary tumour in these patients had been by abdominal surgery (22 patients) or pelvic radiotherapy (20 patients) but 11 of the patients had not received previous abdominal surgery or radiotherapy. All the patients had a laparotomy in an attempt to relieve the obstruction. Seventeen patients had a cause for the obstruction other than secondary malignancy. This was noted particularly when the patients had had pelvic radiotherapy, when radiation change of the ileum causing obstruction was common. Thirty-six patients had obstruction due to secondary tumour and it was found possible to overcome the obstruction in all but two of these. The operative mortality in the patients with secondary malignancy was 19 per cent, but 15 patients (42 per cent) survived for more than a year and the median survival was 11 months. It is concluded that a policy of aggressive surgical intervention is desirable in patients who develop small bowel obstruction after previous treatment for malignant disease.