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Rare case of tibial hemimelia,preaxial polydactyly,and club foot

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World Journal of Clinical Cases 2016年第12期4卷 401-408页

作者： Guinevere Granite John E Herzenberg Ronald Wade Department of Anatomy and Neurobiology School of MedicineUniversity of Maryland Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore Department of Anatomical Services University of Maryland

A seven-month old female presented with left tibial hemimelia(or congenital tibial aplasia; Weber type VIIb, Jones et al type 1a), seven-toed preaxial polydactyly, and severe club foot(congenital talipes equinovarus). Definitive amputation surgery disarticulated the lower limb at the knee. This case report describes the anatomical findings of a systematic post-amputation examination of the lower limb's superficial dissection, X-ray s, and computed to mography (CT) scans. From the X-rays and CT scans, we found curved and overlapping preaxial supernumerary toes, hypoplastic first metatarsal, lack of middle and distal phalanges in one supernumerary toe, three tarsal bones, hypoplastic middle phalanx and no distal phalanx for fourth toe, andno middle or distal phalanges for fifth toe. The fibula articulated with the anteromedial calcaneus and the tibia was completely absent. We identified numerous muscles and nerves in the superficial dissection that are described in the results section of the case report. Due to the rarity of this combination of anatomical findings, descriptions of such cases are very infrequent in the literature.

关键词： Club foot Congenital talipes equinovarus Preaxial polydactyly Tibial hemimelia Congenital tibial aplasia

Functional physiotherapy method results for the treatment of idiopathic clubfoot

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World Journal of Orthopedics 2019年第6期10卷 235-246页

作者： Noriela Carmen Garcia-Gonzalez Jorge Hodgson-Ravina Armando Aguirre-Jaime Servicio de Rehabilitacion Servicio de Ortopedia y TraumatologiaUnidad de Investigacion Clinica y ExperimentalHospital Universitario Nuestra Senora de CandelariaSanta Cruz de Tenerife 38010Spain Colegio de Enfermeria Laureate International UniversitiesSanta Cruz de Tenerife 38001Spain

BACKGROUND Idiopathic clubfoot is a congenital deformity of multifactorial *** initial treatment is eminently conservative;one of the methods applied is the Functional physiotherapy method(FPM),which includes different approaches:Robert Debré(RD)and Saint-Vincent-de-Paul(SVP)among *** method is based on manipulations of the foot,bandages,splints and exercises adapted to the motor development of the child aimed to achieve a plantigrade and functional *** hypothesis was that the SVP method could be more efficient than the RD method in correcting deformities,and would decrease the rate of *** To compare the RD and SVP methods,specifically regarding the improvement accomplished and the frequency of surgery needed to achieve a plantigrade *** Retrospective study of 71 idiopathic clubfeet of 46 children born between February 2004 and January 2012,who were evaluated and classified in our hospital according to severity by the Dimeglio-Bensahel *** included moderate,severe and very severe ***-four feet were treated with the RD method and 37 feet with the SVP *** outcomes at a minimum of two years were considered as very good(by physiotherapy),good(by percutaneous heel-cord tenotomy),fair(by limited surgery),and poor(by complete surgery).RESULTS Complete release was not required in any case;limited posterior release was done in 23 cases(74%)with the RD method and 9(25%)with the SVP method(P<0.001).The percutaneous heel-cord tenotomy was done in 2 feet treated with the RD method(7%)and 6 feet(17%)treated with the SVP method(P<0.001).Six feet in the RD group(19%)and twenty-one feet(58%)in the SVP group did not require any surgery(P<0.001).CONCLUSION Our study provides evidence of the superiority of the SVP method over the RD method,as a variation of the FPM,for the treatment of idiopathic clubfoot.

关键词： Congenital clubfoot Clubfeet Talipes equinovarus Conservative treatment Physical therapy Physiotherapy techniques Conservative methods

Ponseti method compared with soft-tissue release for the management of clubfoot:A meta-analysis study

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World Journal of Orthopedics 2013年第3期4卷 144-153页

作者： Marios G Lykissas Alvin H Crawford Emily A Eismann Junichi Tamai Division of Pediatric Orthopaedic Surgery Cincinnati Children’s Hospital Medical CenterCincinnatiOH 45229United States

AIM: To compare the functional outcomes of patients who underwent open surgery vs Ponseti method for the management of idiopathic clubfoot and to determine whether correlations exist between functional outcome and radiographic ***: A meta-analysis of the literature was conducted for studies concerning primary treatment of patients with idiopathic clubfoot. We searched PubM ed Medline, EMBASE, and the Cochrane Library databases from January 1950 to October 2011. Meta-analyses were performed on outcomes from 12 studies. Pooled means, SDs, and sample sizes were either identified in the results or calculated based on the results of each ***: Overall, 835 treated idiopathic clubfeet in 516 patients were reviewed. The average follow-up was 15.7 years. Patients managed with Ponseti method did have a higher rate of excellent or good outcome than patients treated with open surgery(0.76 and 0.62, respectively), but not quite to the point of statistical significance(Q = 3.73, P = 0.053). Age at surgery wasnot correlated with the functional outcome for the surgically treated patients(r =-0.32, P = 0.68). A larger anteroposterior talocalcaneal angle was correlated with a higher rate of excellent or good outcomes(r = 0.80, P = 0.006). There were no other significant correlations between the functional and radiographic ***: The Ponseti method should be considered the initial treatment of idiopathic clubfeet, and open surgery should be reserved for clubfeet that cannot be completely corrected.

关键词： Idiopathic clubfoot Congenital talipes equinovarus Ponseti method Surgical release Ponseti-Laaveg score

Factors associated with recurrence of clubfoot treated by the Ponseti method

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World Journal of Clinical Cases 2016年第10期4卷 318-322页

作者： Mohammad Reza Azarpira Mohammad Jafar Emami Amir Reza Vosoughi Keivan Rahbari Bone and Joint Diseases Research Center Shiraz University of Medical Sciences

AIM To assess several associated factors on the recurrence of clubfoot after successful correction by the Ponseti method. METHODS A total of 115 children with 196 clubfeet deformities, treated by the Ponseti method, were evaluated. Demographic data, family history of clubfoot in firstdegree relatives, maternal educational level and brace compliance were enquired. Based on their medical files, the characteristics of the patients at the time of presentation such as age, possible associated neuromuscular disease or especial syndrome, severity of the deformity according to the Dimeglio grade and Pirani score, residual deformity after previous Ponseti method and number of casts needed for the correction were *** There were 83 boys(72.2%) and 32 girls(27.8%) with a male to female ratio of 2.6. The mean age at the initiation of treatment was 5.4 d(range: 1 to 60 d). The average number of casts applied to achieve complete correction of all clubfoot deformities was 4.2. Follow-up range was 11 to 60 mo. In total, 39 feet had recurrence with a minimum Dimeglio grade of 1 or Pirani score of 0.5 at the follow-up visit. More recurrence was observed in non-idiopathic clubfoot deformities(P = 0.001), noncompliance to wear braces(P < 0.001), low educational level of mother(P = 0.033), increased number of casts(P < 0.001), and more follow-up periods(P < 0.001). No increase in the possibility of recurrence was observed when the previous unsuccessful casting was further treated using the Ponseti method(P = 0.091). Also, no significant correlation was found for variables of age(P = 0.763), Dimeglio grade(P = 0.875), and Pirani score(P = 0.624) obtaining at the beginning of the serial casting. CONCLUSION Using the Ponseti method, non-idiopathic clubfoot, noncompliance to wear braces, low educational level of mother, increased number of casts and more followup periods had more association to possible increase in recurrence rate after correction of clubfoot deformity.

关键词： Clubfoot Recurrence Cast Talipes equinovarus Ponseti

Lateral Intra-Articular Transposition of the Anterior Tibialis Tendon for the Treatment of Relapsed Clubfoot in Toddlers: A Previously Unreported Surgical Technique

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Open Journal of Orthopedics 2014年第3期4卷 53-59页

作者： Dayton Opel Samuel Abrams Matthew Halanski Kenneth Noonan Department of Orthopedics and Rehabilitation University of Wisconsin Madison USA University of Wisconsin School of Medicine and Public Health Madison USA

Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.

关键词： Clubfoot Clubfoot Relapse Idiopathic Clubfoot Anterior Tibialis Tendon Transfer Ponseti Residual Foot Deformity Talipes equinovarus

Term Pregnancy in a Patient with Septate Uterus: Incidental Finding at Caesarean Section

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Case Reports in Clinical Medicine 2014年第3期3卷 114-117页

作者： Adebiyi G. Adesiyun Solomon Avidime Hajaratu Umar Ranyang Akafa Rabi’at Aliyu Department of Obstetrics & Gynaecology Ahmadu Bello University Teaching Hospital Zaria Nigeria

Mullerian duct anomalies are the most common congenital anomalies of the reproductive system and septate uterus is the most frequently diagnosed Müllerian anomaly. The true incidence of Mullerian duct anomalies is difficult to state because some cases may be asymptomatic and there are pitfalls associated with various diagnostic methods. This is a case report of a 17-year-old primigravida with septate uterus diagnosed at caesarean section performed at term for cephalo-pelvic disproportion. Baby was delivered with bilateral talipes equinovarus.

关键词： Undiagnosed Septate Uterus Term Pregnancy Talipes equinovarus