Tibial Torsion in Untreated Congenital Clubfoot

Current methods of measurement were reassessed by the study of tibial torsion in 1000 normal legs using the tropometer, the caliper and X-rays. No significant difference in the reproducibility of results was found and the simpler clinical methods appeared to be satisfactory for practical purposes. The spontaneous evolution of leg torsion in clubfoot was studied in forty-two neglected and previously untreated cases, who were seen for the first time after they had begun walking. Comparison with the torsion observed in the legs of healthy children of a corresponding age proved that untreated clubfoot is not associated with pathological torsion. The place of rotation osteotomy in the treatment of clubfoot is discussed.     

距下完全松解术治疗儿童先天性马蹄内翻足

目的：分析距下完全松解术治疗儿童先天性马蹄内翻足的临床疗效。方法：应用距下完全松解术治疗32例的儿童44只先天性马蹄内翻足。其中男15例19足，女17例25足。单侧发病者20例，双侧发病者12例(男4例，女8例)。术时平均年龄13个月(年龄范围8-18个月)，平均足长度为11．5cm(长度范围8．5-13cm)。平均随访时间为19个月，最短11个月，最长3年。用Gavceau评定标准来评定疗效。结果：本组无一例伤口感染，未出现过度矫正，无距骨坏死，足畸形矫正总优良率97．7％。结论：距下完全松解术对儿童先天性马蹄内翻足是一种良好的手术方法，值得临床推广使用。     

先天性马蹄内翻足早期肌力平衡术后足部骨骼X线研究

目的：研究先天性马蹄内翻足早期肌力平衡术后足部骨骼改变情况。方法：对46例单侧先天性马蹄内翻足早期肌力平衡术后健、患侧足X线结果进行研究。结果：CCF肌力平衡术后距、舟骨均有不同程度改变，主要表现为距骨头变小、体扁平，舟骨内移及距跟角变小；舟骨内移、前足继发外翻与转移肌腱附丽点位置、张力及内侧关节囊松解与否有关；6个月以内术后骨骼异常尤为明显。结论：X线检查结果不失为评价CCF术后疗效的有效指标之一；早期肌力平衡手术不宜过早（小于6个月）施行；转移肌腱附于第3楔状骨较为理想，内侧关节囊松解不宜过度。     

The Classic: Observations on Pathogenesis and Treatment of Congenital Clubfoot

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Jeronimo Campos, Observations on Pathogenesis and Treatment of Congenital Clubfoot. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI  10.1007/s11999-009-0719-8 and a second Classic article is available at  10.1007/s11999-009-0720-2. This article is ©1972 by Lippincott Williams and Wilkins and is reprinted with permission from Ponseti IV, Campos J. Observations on Pathogenesis and Treatment of Congenital Clubfoot. Clin Orthop Relat Res. 1972;84:50–60.     

Diabetic Muscle Infraction: An Unusual Cause of Muscle Pain in a Diabetic Patient on Hemodialysis

Diabetic muscle infarction (DMI) is a rare, painful and potentially serious complication in patients with poorly controlled diabetes mellitus and frequently misdiagnosed clinically as abscess, neoplasm, or myositis. A 36-year-old diabetic woman referred to our clinic with severe pain in the left antero-medial thigh. She had a 15-year history of Type 2 diabetes mellitus (DM). She was complicated by diabetic nephropathy and requiring hemodialysis. She had first noticed pain and swelling in her left thigh after a minimal trauma for 2 days prior to presentation. Clinical and laboratory evaluation, and muscle biopsy revealed the diagnosis of muscle infarctions. She did no respond to the conservative therapy. Pain and swelling in her thigh worsened progressively. She underwent surgical debridment and then, her clinical status improved. We describe the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that unnecessary investigation and overzealous therapy can be avoided.     

Tibial Metastasis from Muscle Invasive Bladder Carcinoma: An Unusual Site

We report a case of a 61-year-old gentleman who presented with frank hematuria with associated weight loss and on-going left knee pain. Subsequent investigation revealed a muscle invasive bladder carcinoma with a related unusual bone metastasis. Though bone metastases form bladder carcinoma are common, frequent deposition sites include the spinal column and pelvis. This case report is to the best of our knowledge the first reported case of a tibial metastasis for relevant bladder carcinoma. Furthermore, we reviewed the literature, relevant diagnostic and management surrounding such occurrences.Key Words: Bladder neoplasm, Carcinoma, Bone metastasis     

Flexor Carpi Radialis Brevis: An Unusual Anomalous Muscle of the Wrist

During imaging studies or surgical procedures, anomalous forearm and wrist muscles are occasionally encountered. Among them, the flexor carpi radialis brevis is very rare. Because the trend is growing toward treating distal radius fractures with volar plating, the flexor carpi radialis brevis is worth knowing. Here, we report two cases with a review of the literature.     

Intraoperative Muscle Damage in Total Hip Arthroplasty

Tenderness in the medial and posterior thigh is sometimes observed during the early postoperative period after total hip arthroplasty (THA). In this study, the possible correlations of preoperative hip range of motion, surgical approach, and limb lengthening with postoperative muscle strain injury in THA were investigated. Sixty primary THA patients given the posterolateral approach or direct-lateral approach were examined. For comparison of the muscle strain injury in the 2 groups, we used magnetic resonance imaging. There were significant differences in postoperative thigh pain between cases in the posterolateral group with reduction of internal rotation and those with no reduction, and between cases in the direct-lateral group with reduction of external rotation and those with no reduction.     

Congenital Anomalous Chordae Tendinae of the Mitral Valve: An Unusual Presentation of Mitral Insufficiency in Children

Abstract : Anomalous chordae tendinae (CT) originating from mitral valve leaflet is a rare congenital mitral valve anomaly. Our case report is unique as this anomaly is extremely rare in this pediatric age group. The anomalous CT extended from anterior mitral leaflet to the atrial septum (AS). Surgical repair in the form of anomalous CT excision, anterior leaflet chordoplasty, and posterior mitral annuloplasty was successfully performed. Congenital mitral valve (MV) leaflet or chordae anomalies are rare. In anomalous CT from MV leaflet to the AS, the surgical experience is extremely limited and only reported in adults and adolescents. 1 - 4 We describe an unusual presentation of severe mitral insufficiency (MR) associated with anomalous CT from the anterior mitral valve leaflet (AMVL) to the AS that prompted successful repair during childhood. (J Card Surg 2010;25:584‐585)