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Background: Surgical treatment of forearm deformities in patients with multiple cartilaginous exostoses remains controversial. The purpose of the present study was to determine the reasonable indications for operative treatment and to evaluate long-term results of forearm surgery in these patients.Methods: We retrospectively reviewed twenty-three patients (thirty-one forearms) after a mean duration of follow-up of nearly thirteen years. The mean age at the time of the initial procedure was eleven years. The patients underwent a variety of surgical procedures, including excision of exostoses; corrective procedures (lengthening of the radius or ulna and/or corrective osteotomy of the radius and/or ulna) and open reduction or excision of a dislocated radial head. Clinical evaluation involved the assessment of pain, activities of daily living, the cosmetic outcome, and the ranges of motion of the wrist, forearm, and elbow. The radiographic parameters that were assessed were ulnar variance, the radial articular angle, and carpal slip.Results: Four patients had mild pain, and five patients had mild restriction of daily activities at the time of follow-up. Eight patients stated that the appearance of the forearm was unsatisfactory. Radiographic parameters (ulnar variance, radial articular angle, carpal slip) were initially improved; however, at the time of the final follow-up visit, the deformities had again progressed and showed no significant improvement. The only procedure that was associated with complications was ulnar lengthening. Complications included nonunion (three forearms), fracture of callus at the site of lengthening (two forearms), and temporary radial nerve paresis following an ulnar distraction osteotomy (one forearm). Excision of exostoses significantly improved the range of pronation (p = 0.036).Conclusions: In our patients with multiple cartilaginous exostoses, corrective osteotomy and/or lengthening of forearm bones was not beneficial. The most beneficial procedure was excision of exostoses. Reasonable indications for forearm surgery in these patients are (1) to improve forearm rotation and (2) to improve the appearance. [ABSTRACT FROM AUTHOR]

We report three cases of spinal osteoblastoma with ossification of the ligamentum flavum (OLF) adjacent to the tumor. The patients in this report, all young adults, had no symptoms except for back pain. Computed tomography (CT) demonstrated a typical radiolucent nidus in the spinal pedicle/lamina with a dense sclerotic rim. In addition, ectopic bone formation at the insertion point of the ligamentum flavum adjacent to the tumor was clearly illustrated. Magnetic resonance imaging (MRI) revealed the tumor and surrounding inflammatory responses, but OLF was not detected clearly. Histological examination revealed endochondral ossification of the ligamentum flavum that is quite unusual for normal young adults. Immunohistochemical assays in one case demonstrated that bone morphogenetic protein (BMP)-2/4 was expressed in the osteoblastic tumor cells. This case raises the possibility that BMPs secreted from the tumor cells triggered ectopic ossification in the spinal ligament. [ABSTRACT FROM AUTHOR]

This report presents five cases of Apert’s syndrome with features of acrocephaly, characteristic face and complete syndactyly of the hand and foot with bony fusion. Three cases out of five showed preaxial polydactylies of the foot, considered to be one of the characteristic features of Carpenter’s syndrome. In the remaining two cases, the first digital ray of the foot was broad and deformed. In addition one case had a postaxial polydactyly of the hand. Three cases showed severe deformity of the shoulder; two had dysplasia and one had synchondrosis of the glenohumeral joint. On the basis of our findings in this, we feel that there is much phenotypic overlap between Apert’s and Carpenter’s syndrome. A polydactylous presentation of the hand and foot can be found in not a few cases of Apert’s syndrome and it is not always an exclusive feature of Carpenter’s syndrome. [ABSTRACT FROM PUBLISHER]

STUDY DESIGN.: Review article. OBJECTIVE.: To discuss indications and timing of surgery for patients with significant ossification of the posterior longitudinal ligament (OPLL) who show no or only mild myelopathic symptoms. SUMMARY OF BACKGROUND DATA.: Among patients with cervical spinal cord injury, the incidence of patients with OPLL is relatively high, and most had no obvious symptoms of cervical myelopathy. METHODS.: These topics were discussed on the basis of clinical practice guidelines for ossification of the posterior longitudinal ligament as published in 2005 by the Japanese Orthopaedic Association and the Committee on Research into OPLL under the auspices of the Ministry of Health, Labor and Welfare. RESULTS.: No evidence supports the usefulness of surgery for patients with significant OPLL without or with only mild cervical myelopathy. CONCLUSION.: 'Prophylactic' surgery for patients with significant OPLL without or with only mild cervical myelopathy cannot be recommended on the basis of the existing evidence. [ABSTRACT FROM AUTHOR]