Chronic osteomyelitis of clavicle as primary manifestation of SAPHO syndrome in adolescents: report of four cases and long-term evolution.

Four cases of chronic osteomyelitis of clavicle as primary manifestation of synovitis, acne, pustulosis, hyperostosis, osteomyelitis (SAPHO) are reported in adolescents. In all cases a typical radiographical evolution had been observed with progressive slow migration of sclerotic area from medial to lateral side of clavicle. Long-term evolution was alternation of remission and exacerbation but none of the patients healed.

Focal fibrocartilaginous dysplasia of the tibia: long-term evolution.

Focal fibrocartilaginous dysplasia of the tibia (FFCD) is a rare and benign condition associated with unilateral tibia vara in childhood. The first description was done by Bell in 1985. Since then more than sixty cases have been reported. The aetiology remains unknown. Five new cases are retrospectively reported. Four of them with tibia vara less than 30 degrees showed a spontaneous correction. One patient had a severe varus deformity (> 30 degrees) leading to physeal impairment and underwent a tibial valgus osteotomy. Biopsy is not necessary as radiographs are typical. The infantile growth plate is able to correct a tibia vara due to FFCD if less than 30 degrees. In case of spontaneous resolution, a long-term follow-up remains necessary because of a possible progressive leg length discrepancy.

Clinical and radiographic features of operatively treated stiff clubfeet after skeletal maturity: etiology of the deformities and how to prevent them.

BACKGROUND: Residual deformities of operatively treated severe clubfeet evaluated radiographically have been rarely studied in detail in adults. METHODS: Twenty-five operatively treated stiff clubfeet were analyzed at a mean age of 21 years and 6 months. The clinical evaluation used the Laaveg and Ponseti scale for clubfeet. Radiographic assessment was done with weightbearing and dynamic views. RESULTS: Clinical evaluation was globally good except for motion (poor). Radiographic assessment showed residual abnormalities in all feet. The distal tibial epiphysis showed slanting of its posterior part in seven feet (28%) and notching of its anterior lip in 13 (52%). Talar length, calcaneal length, and talar trochlear height were significantly smaller in clubfeet compared to normal feet. Undercorrection of hindfoot varus, was found in 19 feet (76%) but was well tolerated. Navicular wedging was present in seven (28%), and cavus deformity was found in seven (28%). Dorsal bunion, hallux varus, and skewfoot were found in four (16%), two (8%), and three (12%), respectively. The dynamic views demonstrated a significant decrease in the foot and ankle mobility with compensation mechanisms such as anterior talar incongruence or midfoot hypermobility. CONCLUSION: Severe clubfeet never become normal at adult age either clinically or radiographically. Multiple radiographic deformities exist. Their etiology and possible prevention are discussed. Despite the numerous abnormalities, clinical results were good at skeletal maturity.

Long-term survivorship analysis of cemented total hip replacement (THR) after avascular necrosis of the femoral head in renal transplant recipients.

BACKGROUND: We studied the long-term survival and the rate of revision of 93 consecutive total hip replacements (THRs) performed for avascular necrosis of the femoral head after renal transplantation from 1971 to 1988. Seventy-four were primary procedures while 19 hips had undergone previous surgery procedures on the same hip in the form of other conservative options. METHODS: The patients of mean age of 38 years were analysed by the Kaplan-Meier method with revision for any reason as the end-point. The follow-up period averaged 216 months (range 1-332). RESULTS: Thirteen hips were revised while 26 patients (36 hips) died during the follow-up period. The cumulative survival of the implant was 98.8% at 10 years and 63.8% at 20 years. CONCLUSIONS: Cemented THR performed after renal transplantation is satisfactory and, at least for the first 10 post-operative years, the results are equivalent to those obtained in the general population with primary osteoarthritis.

Orthopaedic complications associated with sickle-cell disease.

Sickle cell disease is the most frequent haemoglobinopathy in the world. It affects mostly African descent, but is also present in whites in Greece, Turkey, Italy and India. The responsible gene is autosomal co-dominant and only individuals homozygous for the gene are symptomatic. The condition is characterised by haemolytic anaemia crises and cardio-pulmonary, digestive, neurological, ocular and osteo-articular manifestations. Osteo-articular complications are frequent and may compromise harmonious growth. This retrospective study reports the osteo-articular complications associated with sickle-cell disease encountered in our institution from 1975 to 2004. Orthopaedic complications were reported in 79 patients out of 325 who were followed with sickle-cell disease.

Primary chronic sclerosing osteomyelitis--a case-report.

A case of primary chronic sclerosing osteomyelitis of the fibula in a 14-year-old is described. This rare condition can be difficult to differentiate from a bone tumor. Its pathogenesis is controversial, although the prevalent hypothesis involves chronic osteomyelitis developing after an unrecognized phase of acute infection. The existence of primary chronic sclerosing osteomyelitis as a disease in its own right has been challenged. Recently, primary chronic sclerosing osteomyelitis has been interpreted as a localized or monofocal variant of multifocal recurrent chronic osteitis or of the bone abnormalities associated with seronegative spondyloarthropathies (SAPHO syndrome).

Prospective functional analysis of trapeziectomy combined with intermetacarpal tendon stabilisation in trapeziometacarpal arthritis.

We conducted a prospective study to evaluate the functional status of patients surgically treated by trapeziectomy with intermetacarpal tendon stabilisation. Pain relief, the height of the trapezial cavity, hand impairment, and manual ability were measured in a group of 18 patients at a mean of 2.3 years after surgery. Complete relief of pain was achieved in 89% of our patients. The height of the trapezial cavity was significantly reduced. Hand strength and digital dexterity were not impaired after the operation. Manual ability was significantly improved by the trapeziectomy as demonstrated by the median VAS values of 53.5 before and 95.5 after surgery. The ABILHAND questionnaire revealed that most of the patients were satisfied with the functional results of the trapeziectomy. Based on our findings in this prospective study, it appears that trapeziectomy with intermetacarpal tendon stabilisation relieved pain in almost 90% of patients suffering from trapeziometacarpal osteoarthritis, at no functional cost.

Orthopaedic concerns in children with growth hormone therapy.

Growth hormone (GH) therapy is widely used in children; it may have various severe orthopaedic complications. Slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, scoliosis and carpal tunnel syndrome may occur with GH treatment. Before beginning GH therapy, it is important to take into account all the risk factors of the individual patient, as some conditions could contraindicate GH treatment. During GH treatment, close monitoring with both clinical and radiographic examination is mandatory. The paediatric orthopaedic surgeon will frequently be asked about the management of these complications and about the necessity for treatment arrest. The authors review the orthopaedic complications which the orthopaedic surgeon may encounter in patients treated with GH.

Comparison of posteromedial and subtalar release in surgical treatment of resistant clubfoot.

This preliminary study evalluated two surgical techniques for the treatment of resistant clubfoot: the posteromedial and the subtalar release. Two groups of matched patients with idiopathic clubfoot who underwent surgery between 1983 and 1995 were compared. In group 1 (12 patients, 18 feet), posteromedial release was performed. In this group, the results were satisfactory with a tendency to hypocorrection: 4 (22%) feet needed a secondary procedure (average follow-up: 97.8 months). Group 2 (12 patients, 17 feet) underwent complete subtalar release. The results were clinically better for group 2 (average follow-up: 38.8 months). Only 1 (5.9%) patient needed a secondary procedure. These results suggest complete subtalar release yields better postoperative correction than posteromedial release.