Relationship Between Recurrent Adductus Deformity of the Forefoot and Achilles Tendon Elongation Following Ponseti Treatment in Children with Idiopathic Clubfoot.

BACKGROUND: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. However, this possible underlying mechanism behind recurrence has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by the Ponseti method. METHODS: A retrospective chart review was performed on 20 children (14 boys and six girls; mean age, 7 years; age range, 5-9 years) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was measured ultrasonographically. RESULTS: The plantarflexion-to-dorsiflexion ratio was lower on the involved side (P = .001). No significant differences in the strength ratio of inversion to eversion were found (P = .4). No difference was observed in lengths of tibialis anterior and posterior tendons (P = .1), but the Achilles tendon was longer on the involved side (P = .001; P < .01). A significant negative correlation was discovered between involved-to-uninvolved Achilles tendon length ratios and involved-to-uninvolved plantarflexion strength ratios (r = -0.524; P = .02) Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with relapsed forefoot adduction treated by the Ponseti technique.

Reliability of Computer-Assisted and Manual Measurement Methods for Assessment of Graf Type 1 and Type 2 Hip Sonograms.

OBJECTIVES: The purpose of this study was to investigate the interobserver, intraobserver, and intermethod reliability of computer-assisted digital and manual measurements of hip sonograms. METHODS: Seventy-four hip sonograms were evaluated in this retrospective study. Five evaluators measured digital images and manual paper printouts according to the Graf method (Arch Orthop Trauma Surg 1984; 102:248-255). Interobserver and intraobserver reliability rates were calculated. Reliability criteria were graded on a numeric scale. RESULTS: The interobserver reliability of both computer-based and manual methods for alpha angle measurements was good to excellent, but the interobserver reliability was fair to poor for beta angle measurements. Intraobserver reliability was varied. Alpha angle measurements by both manual and computer-based methods had high concordance with each other, whereas beta angle measurements had low concordance. The intermethod variability did not differ between observers. CONCLUSIONS: The alpha angle measurements had high concordance with each other for both manual and computer-based methods, whereas the beta angle measurements had low concordance. This information should be taken into account in clinical practice. Overall, the two measurement methods were reliable and consistent with each other.

The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study.

PURPOSE: This study investigated the sonographic properties of drug packets containing narcotic drugs and the diagnostic role of ultrasonography in detecting body packing in comparison with CT. METHODS: Forty-five suspects admitted to our hospital for diagnosis and management were routinely evaluated by non-contrast CT for the presence of drug packets. A single radiologist blind to CT data independently performed the abdominal ultrasonographic scans. RESULTS: Thirty-five of 45 suspects were carrying packets. In positive cases, two types of packets with different properties were noted. Twenty-eight cases had type 1 packets (solid form drug) and 7 had type 2 packets (liquid form cocaine). The sensitivity, specificity, positive, and negative predictive values of ultrasonography for detecting drug packets were 91%, 70%, 91%, and 70%, respectively. Ultrasonography accurately determined the presence or absence of packs in 39 of 45 suspects. CONCLUSION: Ultrasonography was found to have a high sensitivity but a low specificity in suspected cases. A negative ultrasonography cannot rule out the diagnosis of body packing. However, it may be preferred as the initial imaging method or for follow-up of suspected cases as a radiation-free, easy-to-use, and inexpensive technique.