Evolution of clubfoot deformity and muscle abnormality in the Ponseti method: evaluation with the Dimeglio score.

PURPOSE: The modality of progression of the correction along casting sessions of Ponseti method has been poorly investigated and information regarding evolution of muscular abnormalities is missing. The aim of the study was to investigate dynamics of correction of the different components of clubfoot deformity in a clinical setting. METHODS: In a prospective study, 124 clubfeet consecutively treated by a single orthopaedic surgeon were evaluated with the Dimeglio system at each casting session and score progression was determined. RESULTS: For each component a typical pattern was recorded. Cavus and medial crease showed a rapid correction. Rotation, adduction and varus corrected gradually and simultaneously. The posterior crease usually persisted until final cast was discontinued. Equinus improved progressively after each cast and then to a larger extent with Achilles tenotomy. The parameter describing poor muscular condition, reported at presentation in 39 feet (31.5%), was the only item showing extremely different dynamics of correction (from rapid and complete resolution to persistence at last cast removal), which could be explained by the large diversity of entities included (hypertonia, imbalance, fatty infiltration, fibrosis, aplasia). CONCLUSIONS: This study confirmed that dynamics of correction in clinical setting correspond essentially to theoretical principles of Ponseti method. Muscle abnormalities are not uncommon in clubfeet and have great influence on the progression of correction. If abnormalities are recorded, their evolution along the treatment should be monitored. A more objective evaluation would be required.

Osteoid osteoma of the distal thumb phalanx: a case report.

Osteoid osteomas of the hand are uncommon. Particularly, location in the thumb and involvement of the distal phalanx are very rarely reported. Long diagnostic delay and inadequate treatment are typical, since clinical features may mimic other causes more frequently found in the same site (post-traumatic, infective, rheumatic, neoplastic conditions, regional pain syndrome) and even the nail morphology may be altered, as in the reported case (watch-glass deformity). A case of an osteoid osteoma of the distal thumb phalanx in a 27-year-old man is presented, along with its clinical, radiographic and CT findings. In the Authors' opinion, curettage should be considered the treatment of choice.

Low-intensity optical bistability in an active Fabry-Perot mirror induced by input-phase-insensitive parametric downconversion.

A Fabry-Perot resonator filled with second-order nonlinear optical material is investigated. Attention is devoted to making the resonator act as a nonlinear mirror for ultralow-intensity light signals that can be switched by a control beam at the second-harmonic frequency. The interaction process is an input-phase-independent parametric downconversion. The theoretical problem is solved through implementation of a dummy variable method optimized for a parametric process. Efficient amplification and bistability of low-intensity signals have been found.