Hypermobile lateral meniscus: A systematic review of current treatment options.

PURPOSE: The reliable data on the incidence of hypermobile lateral meniscus (HLM) and its clinical manifestations, diagnostic methods and therapeutic approaches are limited. This systematic study aimed to review available treatment options for HLM and the outcomes of each approach. METHODS: A systematic search was performed in four electronic databases (PubMed, EMBASE, Scopus, Web of Science) to identify studies in which arthroscopically confirmed cases of HLM were treated surgically or nonsurgically, and the required data comprising study characteristics, patient data, treatment approaches and outcome measures were extracted from eligible studies. RESULTS: Twenty studies with a total of 212 patients (138 males and 74 females) and 219 knees were included. The most frequently reported symptoms were locking sensations, knee pain, giving way and snapping. Treatments used by the studies were: radiofrequency energy in two studies; arthroscopic partial meniscectomy in one study; open surgery in two studies; and arthroscopic meniscal repair in 17 studies. Eleven studies used an all-inside repair method and an inside-out meniscal repair was reported in eight studies. Three studies reported the usage of posterior arthroscopy for therapeutic or diagnostic approaches. Evaluation of symptom resolution was the main outcome measurement for which almost all of the studies stated relief of symptoms after intervention. CONCLUSION: Despite the lack of definite consensus about the most appropriate intervention for HLM, therapeutic preference was directed towards arthroscopic all-inside and inside-out repair techniques. Although the surgeon's decision remains the key factor in choosing the most suitable treatment option for each individual, posterior arthroscopic meniscal repair may be considered as a better option for HLM treatment according to the findings of this review. LEVEL OF EVIDENCE: Level IV.

Long-term clinical results of using a posteromedial all-inside and anteromedial inside-out approach to repair unstable or irreducible bucket-handle medial meniscal tears.

BACKGROUND: In irreducible bucket-handle medial meniscal tears (BHMMTs), the displaced central fragment is rotated 180° or more, meaning reduction is impossible without derotation of the tear. In chronic cases, the rotated meniscus is deformed and degenerated; thus, the issue of reproducibility and repairability arises. This study presents the clinical outcomes of chronic irreducible and unstable locked BHMMTs. Radiological outcomes were also evaluated using magnetic resonance imaging (MRI). METHODS: This is a retrospective study of 37 patients with 11 cases of irreducible BHMMT and 26 cases of reducible but unstable chronic BHMMT who underwent operations between 2011 and 2016. Posterior arthroscopy was performed after temporary meniscus fixation using a provisional needle fixation technique. After the posterior repair with vertical mattress sutures was completed using an all-inside technique, the classic outside-in technique was performed for the anterior third of the meniscus. The Lysholm, International Knee Documentation Committee (IKDC), and Tegner activity scores were obtained from all patients before surgery and at the latest follow-up. Radiological evaluations were performed using MRI before surgery and at 6 months postoperatively. RESULTS: Between 2011 and 2016, a total of 37 consecutive patients with irreducible and chronic BHMMTs underwent surgery. The average postoperative follow-up was 7.2 ± 1.4 years (mean ± SD). Postoperative Lysholm (89.57 ± 2.7) and IKDC (87.22 ± 3.2) scores improved significantly at the last follow-up when compared with the pre-operative scores (38.44 ± 4.5 and 23.52 ± 7.8, respectively). According to the Tegner activity scale, patients' postoperative activity levels remained unchanged compared to preoperative levels at the last follow-up. CONCLUSION: Posterior knee arthroscopy with the all-inside posterior suture and inside-out anteromedial suture technique presented in this study yielded excellent clinical outcomes when used to repair chronic irreducible or unstable BHMMTs. LEVEL OF EVIDENCE: Level IV.

A systematic review and meta-analysis of the epidemiological characteristics of COVID-19 in children.

BACKGROUND: Several individual studies from specific countries have reported rising numbers of pediatric COVID-19 cases with inconsistent reports on the clinical symptoms including respiratory and gastrointestinal symptoms as well as diverse reports on the mean age and household exposure in children. The epidemiological characteristics of COVID-19 in children are not fully understood, hence, comprehensive meta-analyses are needed to provide a better understanding of these characteristics. METHODS: This review was conducted in Medline, Scopus, Cochrane library, Embase, Web of Science, and published reports on COVID-19 in children. Data were extracted by two independent researchers and a third researcher resolved disputes. STATA software and the random-effect model were used in the synthesis of our data. For each model, the heterogeneity between studies was estimated using the Q Cochrane test. Heterogeneity and publication bias were calculated using the I2 statistic and Egger's/Begg's tests. RESULTS: The qualitative systematic review was performed on 32 articles. Furthermore, the meta-analysis estimated an overall rate of involvement at 12% (95% CI: 9-15%) among children, with an I2 of 98.36%. The proportion of household exposure was calculated to be 50.99% (95% CI: 20.80%-80.80%) and the proportion of admitted cases was calculated to be 45% (95% CI: 24%-67%). Additionally, the prevalence of cough, fatigue, fever and dyspnea was calculated to be 25% (95% CI: 0.16-0.36), 9% (95% CI: 0.03-0.18), 33% (95% CI: 0.21-0.47) and 9% (95% CI: 0.04-0.15), respectively. It is estimated that 4% (95% CI: 1-8%) of cases required intensive care unit admission. CONCLUSIONS: The pediatric clinical picture of COVID-19 is not simply a classic respiratory infection, but unusual presentations have been reported. Given the high incidence of household transmission and atypical clinical presentation in children, we strongly recommend their inclusion in research and population-based preventive measures like vaccination as well as clinical trials to ensure efficacy, safety, and tolerability in this age group.

Determination of Normal Reference Values for Meniscal Extrusion Using Ultrasonography During the Different Range of Motion: A Pilot, Feasibility Study.

OBJECTIVES: It is essential to know the normal extrusion measures in order to detect pathological ones. In this study, we aimed to define some normal reference values for meniscal extrusion in the normal knees during different ranges of motion. METHODS: The amount of anterior and posterior portion of meniscal extrusion among 21 asymptomatic volunteers (42 knees) were tracked in 0, 45, and 90° of knee flexion using an ultrasound machine. The repeated measures analysis of variance (ANOVA) was used to show the interaction between the amounts of meniscal extrusion and the different degrees of knee flexion. RESULTS: The anterior portion of the lateral menisci at full knee extension (0.59 ± 1.40) and the posterior portion of the medial menisci during 90° flexion (3.06 ± 2.36) showed the smallest and the highest mean amount of extrusion, respectively. The normal average amounts of anterior extrusion were 1.12 ± 1.17 and 0.99 ± 1.34 mm for medial and lateral menisci, respectively. The posterior meniscal normal extrusions were significantly increasing in both medial and lateral menisci during the survey (F = 20.250 and 11.298; both P values <.001) as they were measured 2.37 ± 2.16 and 1.53 ± 2.18 mm in order. CONCLUSIONS: The medial meniscus can extrude 1.74 ± 1.84 mm normally while this amount was 1.26 ± 1.82 mm for the lateral meniscus. These measures commonly increased with the rising of knee flexion motion. Likewise, the posterior portion showed more extrusion than the anterior portion on both sides. These measures commonly increased with higher knee flexion.

Open knee dislocation, triple intra-articular fractures and patellar tendon rupture: case report of a knee disaster treated with aggressive irrigation/debridement, early anatomic reduction and internal fixation.

BACKGROUND: Open knee fracture-dislocation is a rare orthopedic injury. However, the importance of its correct management could not be overstated. To the best of our knowledge, this is the fifth study reporting a case with simultaneous Hoffa fracture and knee dislocation and the 1st study describing a patient with open plateau fracture-dislocation accompanied with Hoffa fracture, patella fracture, and patellar tendon tear. In addition, this report is noticeable as our case had no gross ligament injury unlike frequent association of knee dislocation with knee collateral ligament damage. CASE PRESENTATION: In this study, we describe a 34-year-old motorcyclist referred to our center following a motor car accident. Further work-up revealed an open irreducible posterolateral knee dislocation, type 5 Hohl and Moore plateau fracture, lateral femoral condyle Hoffa's fracture, patellar fracture, and patellar tendon tear of his right knee. During an open reduction, it turned out that an entrapped lateral meniscus prevented the joint to be reduced by closed means. After applying a temporary external fixator, the patient was finally managed with open reduction and internal fixation. CONCLUSION: Irreducible knee dislocation needs further work up to rule out any interposed soft tissue into the joint. Aggressive irrigation/ debridement, early anatomic reduction, and internal fixation may help reduce open fracture complications including infection, non-union, and stiffness.

The functional impact of home-based self-rehabilitation following arthroscopic meniscus root repair.

BACKGROUND: Corona virus infectious pandemic makes outdoors rehabilitation a potential hazard. Patient education to perform simple home-based exercises seems to be an interesting and sometimes a mandatory option. This study provides a comparison between the conventional and home-based virtual rehabilitation after surgical repair of medial meniscus root tears. METHODS: In this prospective study, all patients who underwent medial meniscus posterior root repair with a modified trans-tibial pull-out technique from March 2019 to March 2021 were evaluated. Those who underwent surgery after December 2019 were trained to perform self-rehabilitation. The rest had undergone outdoors specialized rehabilitation according to a unified protocol and these were used as a historical control group. All patients were followed up for a minimum of 2 year after surgery. Final Lysholm scores were utilized to compare functional outcomes after considering the effect of age, body mass index and time from surgery by multivariate linear regression analysis. RESULTS: Forty-three consecutive patients with medial meniscal root tears were studied. Thirty-nine (90.7%) were women and 4 (9.3%) were men. The mean age of participants was 53.2 ± 8.1 years. The total Lysholm knee score, and all its items were significantly improved in both groups at a two-year follow-up (p < 0.05), except the "Using cane or crutches" item (p = 0.065). Nevertheless, the final Lysholm knee score improvement was higher in patients who performed outdoors specialized rehabilitation and in patients with shorter time-to-surgery. CONCLUSION: Regardless of age and gender, home-based rehabilitation after meniscal root repair with the modified trans-tibial pull-out technique improved the patients' function at a two-year follow-up. Nonetheless, this effect was still significantly lower than that of the outdoors specialized rehabilitation. Future work is required to clarify basic protocols for home-based tele-rehabilitation programs and determine clinical, radiological and functional results. LEVEL OF EVIDENCE: Level IV, therapeutic, historically controlled study.

The path to minimizing instability in developmental dysplasia of the hip: is Capsulorrhaphy a necessity or a futile habit?

BACKGROUND: To evaluate and quantify the intraoperative effect of capsulorrhaphy on the deep seating of femoral head within the acetabulum as measured by medial joint space, a surrogate measure of acetabular-head contact. METHODS: In order to determine the exact effect of capsulorrhaphy, we prospectively scrutinized a consecutive sample of 18 patients with unilateral dysplastic hips aging > 18 months and followed them for a period of at least 12 months. The procedure of open reduction is described in detail. Two pediatric orthopedists carried out the operations from August 2014 to January 2019 at a tertiary pediatric hospital. Intraoperatively, AP radiographs of the pelvis were obtained before and after capsulorrhaphy. The distance between the inferomedial edge of the proximal femoral metaphysis and the lateral edge of the obturator foramen was recorded. To determine if there were differences in medial joint space due to capsulorrhaphy, a generalized linear model was run on the study sample. All patients were followed for at least 12 months to determine the rate of re-dislocation. RESULTS: Mean age (±standard deviation) of the participants was 37.5 (±24.7) months. All cases underwent Salter osteotomy, 5 cases needed femoral shortening (27.8%) and none needed derotational osteotomy. Capsulorrhaphy lead to a statistically significant decrease in the mean medial joint space from 1.59 cm before (95% CI: 1.12-2.05) to 0.76 cm after (95% CI: 0.50-1.02) the capsulorrhaphy (P < 0.001). When we took the effect of age into account the corresponding figures were 1.47 (95% CI: 1.22-1.75) and 0.67 (95% CI: 0.39-0.94), respectively (P < 0.001). After follow up periods of 1 to 5.5 years, none of the patients experienced instability or re-dislocation. CONCLUSIONS: Capsulorrhaphy, independently, of age was associated with a 1-cm decrease in the mean medial hip joint space and a more deeply seated femoral head. Furthermore, this study presents a successful experience with capsulorrhaphy to prevent hip instability.

Orofaciodigital syndrome type II (Mohr syndrome): a case report.

BACKGROUND: Orofacial digital syndrome is a rare genetic disorder with oral cavity, facial and digits anomalies. Orofacial digital syndrome type II, also called the "Mohr syndrome" is a very rare subtype that has been reported scarcely in Asia especially in Japanese patients. CASE PRESENTATION: The case is an Iranian 5-year old girl who had been admitted for orthopedic surgery. She surprisingly had pre and postaxial polydactyly of all the four limbs concurrent with syndromic face and most of the features of Orofaciodigital syndrome type II. CONCLUSION: Mohr syndrome, anesthesia and surgical considerations are discussed in this case report. It is recommended to consider these considerations and the possibility of OFDS in every child with pre and postaxial polydactyly of the four limbs and to try to distinguish type II from other types of ODFS.

Development of Persian version of the Spinal Cord Independence Measure III assessed by interview: a psychometric study.

STUDY DESIGN: Cross-sectional psychometric study. OBJECTIVES: To translate the Spinal Cord Independence Measure III (SCIM-III) into Persian, to evaluate it culturally and to analyze the validity and reliability of the Persian version of the SCIM-III (P-SCIM). SETTING: Brain and Spinal Injury Research Center (BASIR), Tehran, Iran. METHODS: The P-SCIM was developed by forward translation, back-translation, and cultural equivalence assessment procedure. The authors studied: (a) correlation of P-SCIM with the Functional Independence Measure (FIM™) for determining convergence validity, (b) P-SCIM scores in neurological categories for comparison and evaluating discriminative validity, (c) Inter-rater reliability of P-SCIM, (d) Cronbach's alpha for measuring internal consistency of P-SCIM-III. RESULTS: The validity of the scale was supported by a Pearson correlation coefficient of > 0.9 (p < 0.001) between FIM™ and P-SCIM. The Persian SCIM was found to be valid in discriminating different neurological categories. The Inter-rater reliability was concluded by Intraclass correlations of a coefficient > 0.9. Bland-Altman analysis demonstrated good agreement between our raters (mean difference: 0.7, limit of agreement: - 8.09-9.58). Also internal consistency of the scale was shown by Cronbach's alpha to be > 0.7 (0.86). CONCLUSION: P-SCIM-III is a valid and consistent tool for determining functionality in Persian speaking people with spinal cord injury.

Hypertrophic synovial plica in the lateral side of the knee - A case report: Case report and literature review.

INTRODUCTION: Plicae or synovial folds can be detected in different joints, especially around the knee. Synovial plicae pathologies are rare conditions with difficulty in diagnosis because of various symptoms overlapping with other diseases. PRESENTATION OF CASE: We reported a rare case of symptomatic hypertrophic synovial plica in the lateral side of the knee in a 12-year-old boy following a traumatic event almost two years before the surgery. The diagnosis and treatment were conducted by knee arthroscopy, and follow-up of the patients showed significant improvements with no pain or range of motion restrictions. DISCUSSION: The reported case had a significantly lower age of presentations compared to most previously reported cases, and he was diagnosed with lateral knee hypertrophic plicae, while medial knee hypertrophic plicae are more commonly reported, which is considered rare findings. Contrary to previous studies of lateral plica, our case had a history of significant direct trauma, and he was not a professional athlete. Furthermore, based on evidence, hypertrophic synovial plicae are mostly asymptomatic, but in our case, there was a pain in his knee that worsened in flexion. CONCLUSION: Physicians should consider the possibility of synovial hypertrophic plicae, especially in younger patients with histories of direct traumatic events.

Patellectomy, an old treatment in patellar fracture which is still alive: A case report.

INTRODUCTION: Comminuted patella fractures comprise 55 % of patellar fractures. In spite of advances in internal fixation of patella, patellectomy remains an effective treatment in comminuted fractures. In the shadow of different efficient methods of internal fixation, little attention is paid to patellectomy as an old treatment in patellar fracture which is a treatment option in circumstances like comminuted fractures and osteomyelitis. PRESENTATION OF CASE: A 54-year-old male presented with complaint of knee pain and limited range of motion. The patient experienced patella fracture four years ago and several sessions of surgery have been performed on his patella including tension band wiring, partial patellectomy, and arthroscopic release. Lastly, pain and severe limited range of motion, convinced us to perform total patellectomy. The result is satisfactory after one year; flexion is up to 90° and no limping or extension lag is observed. The only complaint is mild anterior knee pain. DISCUSSION: Patella has two important biomechanical functions including linking and displacement. Preserving even a single fragment of the patella substantially improves linking and displacement function of the patella. Total patellectomy is reserved for conditions like failed internal fixation, comminuted fractures, and patellar osteomyelitis. Although function of the knee cannot be thoroughly restored after removing of the patella, total patellectomy can lead to a relative satisfaction in performing activities of daily living. CONCLUSION: In spite of various types of treatment for patellar fracture, total patellectomy, is still an efficient treatment option in circumstances like comminuted fractures, failed internal fixation, and osteomyelitis.

Subtrochanteric fracture of the femur following knee replacement surgery: A case series and review of the literature.

INTRODUCTION AND IMPORTANCE: Knee arthroplasties as an effective intervention is primarily performed in patients with primary osteoarthritis and rheumatoid arthritis. Risk of hip fracture may be either decreased or increased in patients with Knee arthroplasties. There is conflicting evidence in this regard. Over the years, some studies have reported the occurrence of hip fractures following this operation as a rare but severe complication. The aim of the present case series was to report diagnosis and treatment of the mentioned five cases. CASE PRESENTATION: During a period of two years, five patients with a diagnosis of a subtrochanteric fracture and history of total knee arthroplasty who referred to hospital were selected to include in the present case series. CLINICAL DISCUSSION: the presence of RA and treatment with glucocorticoids, a reduction of BMD following knee replacement surgery, and ultimately, an increase in physical activity and movement after the arthroplasty due to the improvement of preoperational pain, may all contribute in a complex manner to the observed outcome of increased fracture risk in the hip following TKA. CONCLUSION: In summary, special care including using medications to improve BMD should be taken to minimize the risk of such an event.

Is posterior knee arthroscopy using posterior portals necessary for orthopedic surgeons? The latest evidence on applications and techniques.

Various uses of posterior knee arthroscopy have been shown, including all-inside repair of posterior meniscal lesions, posterior cruciate ligament (PCL) reconstruction or PCL avulsion fixation, extensile posterior knee synovectomy for pigmented villonodular synovitis or synovial chondromatosis, posterior capsular release in the setting of knee flexion contractures, and loose bodies removal. Posterior arthroscopy provides direct access to the posterior meniscal borders for adequate abrasion and fibrous tissue removal. This direct view of the knee posterior structures enables the surgeon to create a stronger biomechanical repair using vertical mattress sutures. During PCL reconstruction, posterior arthroscopy gives the surgeon proper double access to the tibial insertion site, which can result in less acute curve angles and the creation of a more anatomic tibial tunnel. Moreover, it gives the best opportunity to preserve the PCL remnant. Arthroscopic PCL avulsion fixation is more time-consuming with a larger cost burden compared to open approaches, but in the case of other concomitant intra-articular injuries, it may lead to a better chance of a return to pre-injury activities. The high learning curve and overcaution of neuromuscular injury have discouraged surgeons from practicing posterior knee arthroscopy using posterior portals. Evidence for using posterior portals by experienced surgeons suggests fewer complications. The evidence suggests toward learning posterior knee arthroscopy, and this technique must be part of the education about arthroscopy. In today's professional sports world, where the quick and complete return of athletes to their professional activities is irreplaceable, the use of posterior knee arthroscopy is necessary.

Predicting the COVID-19 mortality among Iranian patients using tree-based models: A cross-sectional study.

Background and Aims: To explore the use of different machine learning models in prediction of COVID-19 mortality in hospitalized patients. Materials and Methods: A total of 44,112 patients from six academic hospitals who were admitted for COVID-19 between March 2020 and August 2021 were included in this study. Variables were obtained from their electronic medical records. Random forest-recursive feature elimination was used to select key features. Decision tree, random forest, LightGBM, and XGBoost model were developed. Sensitivity, specificity, accuracy, F-1 score, and receiver operating characteristic (ROC)-AUC were used to compare the prediction performance of different models. Results: Random forest-recursive feature elimination selected following features to include in the prediction model: Age, sex, hypertension, malignancy, pneumonia, cardiac problem, cough, dyspnea, and respiratory system disease. XGBoost and LightGBM showed the best performance with an ROC-AUC of 0.83 [0.822-0.842] and 0.83 [0.816-0.837] and sensitivity of 0.77. Conclusion: XGBoost, LightGBM, and random forest have a relatively high predictive performance in prediction of mortality in COVID-19 patients and can be applied in hospital settings, however, future research are needed to externally confirm the validation of these models.

Management of tibial nonunion and osteoarthritis using a 3D-printed titanium cone: A case report.

The use of customized 3D-printed structures has been gaining popularity in non-union management, as it allows for bypassing the defect while promoting osseointegration. Additionally, porous titanium implants minimize stress shielding due to their stiffness and elastic modulus being closer to that of bone. The interconnected channels increase the surface area and provide space for cell adhesion and proliferation. This study presents the case of a 62-year-old female patient with concomitant knee osteoarthritis recalcitrant aseptic atrophic nonunion in the tibial proximal metaphysis. Due to the small distance between the nonunion site and the joint line, nonunion treatment had to be included in the treatment plan, as it would result in a lack of mechanical stability of the tibial component, and techniques such as plating were not an option. A customized 3D-printed porous titanium cone was used to bypass the fracture site and support the stem used with the CCK prosthesis, allowing for simultaneous nonunion and osteoarthritis management.

Ipsilateral Concurrent Knee Arthroplasty and Tibial Osteotomy with 3D-Printed Patient-Specific Instrumentation: A Case Report.

CASE: A 70-year-old woman presented with knee pain and instability and was diagnosed with advanced knee osteoarthritis and bifocal tibial deformities. The complexity of the case challenged our team to perform a significant sagittal correction (>60°) and restore her ability to walk independently. We performed ipsilateral total knee arthroplasty and anterior closed wedge tibial osteotomy using virtual planning and 3D-printed patient-specific instrumentation. CONCLUSION: Using 2 separate 3D-printed patient-specific cutting guides for this patient with a complex deformity and managing the whole planning process in close collaboration between the surgeons and engineers resulted in a satisfactory postoperative outcome, optimal implant positioning and leg alignment, and minimal soft-tissue damage.

Effect of Dexmedetomidine infusion during hip fracture surgery on hemodynamic parameters and blood loss: A triple-blinded Randomized Clinical Trial.

Introduction In this study, we aim to assess the intra-operative effect of dexmedetomidine administration on the hemodynamic parameters and bleeding volume during hip fracture surgery. Patients and methods we designed and implemented a triple-blinded randomized clinical trial to objectively compare the effects of 0.5 µg/kg/h infusion of dexmedetomidine with placebo (equal amount of normal saline) during hip fracture surgery. All included cases were between 30 and 70 years old and underwent surgery for fixation of a proximal femur fracture from September 26, 2020 until February 15, 2021. They were all ASA class I or II with preoperative hemoglobin levels of 10 mg/dL or higher. Surgical blood loss and hemodynamic parameters were documented. Results 76 patients were enrolled. There were no significant differences in baseline patient characteristics. The bleeding rate was 620 ± 190.0 mL for the normal saline group and 476 ± 177.98 mL in the dexmedetomidine group (P = 0.04). No significant effect on hemodynamic parameters was observed. Conclusion Based on the current study, intravenous infusion of dexmedetomidine during hip fracture surgery under general anesthesia reduced the amount of intraoperative bleeding without causing any significant hemodynamic disturbances. Registration number IRCT20191222045857N1 (Iranian Registry of Clinical Trials).

Overview of posterior knee arthroscopy in the medial meniscal repair: Technical note.

Preservation of the meniscus in bucket handle medial meniscal tears (BHMMTs) and posterior meniscocapsular (ramp) lesions is challenging. Current efforts are being made in the scientific community to (1) introduce new ways of gaining easier and better field of view over the repair site and (2) increase the chance of meniscal healing through effective augmentation procedures. The current note introduces a way to achieve good exposure of posterior knee compartments and proposes an augmentation technique that involves exposing the local non-articulating subchondral cancellous bone and making in situ clots.

Clinical, radiological, pedobarographic, and quality of life outcomes of the Ponseti treatment for clubfoot: a prospective study.

BACKGROUND: Talipes equinovarus, also known as clubfoot, is a congenital anomaly that affects one newborn per 1000 live births. Its standard treatment strategy is Ponseti casting management. This study aims to report the long-term outcomes of the Ponseti treatment in Iran. METHODS: A prospective cohort study was enrolled to evaluate clinical outcomes, radiological results, pedobarographic measurements, and quality of life after the Ponseti treatment in patients with clubfoot who were followed for at least five years. RESULTS: In this study, 25 clubfeet of 18 patients were included. Significant reductions in Pirani, Dimeglio, and CAP scores, improved ankle dorsiflexion, and acceptable pedobarographic indices were observed in this study. From the radiological evaluation indices, the calcaneal pitch and lateral talus-first metatarsal angles were significantly reduced. After five years of treatment, patients' quality of life was favorable, which was better in females. This study showed that the results of the Ponseti treatment remained acceptable after five years. CONCLUSIONS: The Ponseti management for clubfoot in the long term appears to maintain significant improvements. However, the recurrence rate - albeit without disruption to daily activities - cannot be ignored.

Periscapular Fibromatosis With Intrathoracic Invasion in a 3-Year-Old Boy.

Fibromatosis is an extremely rare tumor that arises from the myofascial tissue and has high rates of infiltration and recurrence. Fibromatosis of the chest wall is even less common, and wide surgical resection is the preferred treatment alternative to radiation therapy, chemotherapy, and systemic treatments. We report the case of a 3-year-old boy with radiologically and pathologically confirmed fibromatosis of the periscapular region who underwent wide resection. We discuss diagnosis, treatment options, and technical pearls for a desmoid tumor of the chest wall. The resection should go through healthy tissue because of the infiltrative nature of the tumor. Although visceral involvement did not occur in this case, surgeons should be aware of its possibility, and surgery should be performed by a multidisciplinary team, including a pediatric orthopedic surgeon, a thoracic surgeon, and an anesthesiologist. [Orthopedics. 2022;45(5):e276-e279.].