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A child with Spigelian hernia, concomitant multiple skeletal anomalies and whole body hemihypoplasia and fibular aplasia is presented here. Irrespective of the patient's age at presentation, Spigelian hernias associated with anomalies are congenital in origin. This case emphasizes the fact that a bilateral Spigelian hernia can occur in children together with multiple skeletal anomalies.

OBJECTIVE: Anemia is a widespread problem among infants and children in many parts of the world, and it is often associated with some trace elements (iron, zinc, copper) and heavy metals (cadmium and lead). Aim of this study was to investigate the relationship between anemia and these elements. METHODS: This research was performed on 256 children (mean age 6.8 +/- 0.2) living in Denizli city center. We observed iron deficiency anemia (IDA) in 23 children, iron deficiency without anemia (ID) in 36 children and only anemia (ferritin level normal) (OA) in 18 children, and 179 children were found healthy and they were regarded as controls (C). Blood samples were taken from subjects and the concentrations of zinc, copper, iron, cadmium and lead in serum were measured with atomic absorption spectrophotometer. RESULTS: The levels of copper, cadmium and lead in serum were significantly higher in children with IDA than those of controls (p

The effect of genetic factors on hip dislocation, acetabular dysplasia, and developmental dysplasia of the hip (DDH) has long been recognized. In this report, we presented a large family that showed single gene inheritance for DDH. Pedigree analysis of a pregnant woman revealed a history of DDH in 16 members of the family. Although the pedigree showed autosomal dominant inheritance with reduced penetrance, the prevalence of DDH was considerably high, almost accounting for one-third of the family members, and skipping only one generation. Of 16 cases, three patients were diagnosed at our center. The remaining 13 patients were diagnosed at other centers. Dislocation was diagnosed very late in most of the family members, while four cases were diagnosed at birth. All family members were informed by a detailed clinical letter and recommended evaluation for DDH at every birth., Genetik faktörlerin kalça çıkığı, asetabüler displazi ve gelişimsel kalça displazisi (GKD) üzerine etkileri uzun zamandır bilinmektedir. Bu yazıda, oldukça nadir bir durum olan tek gen kalıtımı gösteren GKD’li bir aile sunuldu. Hamile bir kadının pedigri analizi sırasında 16 aile ferdinde GKD öyküsü olduğu öğrenildi. Pedigri analizi düşük penetranslı otozomal dominant kalıtım göstermesine karşın, GKD’li olgu sayısının yüksek olduğu (aile bireylerinin neredeyse üçte biri) ve sadece bir kuşak atladığı görüldü. Olguların üçü kliniğimizde değerlendirildi ve bu hastalara GKD tanısı kondu. Diğer 13 hastaya daha önce başka kliniklerde tanı konmuştu. Kalça çıkığı genellikle çok geç tespit edilmekle beraber, dört olguda tanı doğum sırasında konmuştu. Aile bireyleri ayrıntılı bir klinik mektup ile bilgilendirildi ve aileye her doğumu takiben değerlendirme önerildi.

2017 IEEE International Black Sea Conference on Communications and Networking, BlackSeaCom 2017 -- 5 June 2017 through 8 June 2017 -- 134510 Objective: This study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results. Methods: 29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6–22) years. The mean follow-up was 33 (range 22–59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the bunion in six patients (11 feet); and MTP joint arthrodesis in four patients (7 feet). The hallux valgus angle (HVA) and the anteroposterior intermetatarsal angle (IMA) were used for radiologic evaluation and the DuPont Bunion Rating Score was used for clinical evaluation. Results: The follow-up period was 36 (range 22–59) months in reconstructive group, 27 (range 24–29) months in soft tissue group, and 29 (range 23–41) months in MTP arthrodesis group. Significant improvements were detected in hallux valgus angle in three groups postoperatively but in soft tissue group correction loss was observed during follow up. Best results were achieved in arthrodesis group and worse in soft tissue group in terms of clinical evaluation. Conclusion: According to our results isolated soft tissue procedures are ineffective in CP patients. Soft tissue procedure combined with metatarsal osteotomy has satisfactory results. Level of evidence: Level IV, therapeutic study. © 2018 Turkish Association of Orthopaedics and Traumatology

Disseminated cancer cells that have extravasated into the tissue parenchyma must interact productively with its extracellular matrix components to survive, proliferate, and form macroscopic metastases. The biochemical and cell biologic mechanisms enabling this interaction remain poorly understood. We find that the formation of elongated integrin β1-containing adhesion plaques by cancer cells that have extravasated into the lung parenchyma enables the proliferation of these cells via activation of focal adhesion kinase. These plaques originate in and appear only after the formation of filopodium-like protrusions (FLP) that harbor integrin β1 along their shafts. The cytoskeleton-regulating proteins Rif and mDia2 contribute critically to the formation of these protrusions and thereby enable the proliferation of extravasated cancer cells. Hence, the formation of FLPs represents a critical rate-limiting step for the subsequent development of macroscopic metastases. SIGNIFICANCE: Although the mechanisms of metastatic dissemination have begun to be uncovered, those involved in the establishment of extravasated cancer cells in foreign tissue microenvironments remained largely obscure. We have studied the behavior of recently extravasated cancer cells in the lungs and identified a series of cell biologic processes involving the formation of filopodium-like protrusions and the subsequent development of elongated, mature adhesion plaques, which contribute critically to the rapid proliferation of the micrometastatic cells and thus are prerequisites to the eventual lung colonization by these cells., National Institutes of Health (U.S.) (Grant P01-CA080111)

The aims of this study were to determine factors that cause a leg-length discrepancy (LLD) to the extent that correction is indicated after treatment in developmental dysplasia of the hip and determine whether the LLD may be treated with a percutaneous epiphysiodesis. Twelve children were included in this study. The factors which caused LLD were avascular necrosis, femoral shortening and varus at reduction, and septic arthritis. Percutaneous epiphysiodesis of the contralateral limb reduced the mean predicted LLD from 3.8 to 1.2 cm at maturity. We concluded that LLD (>2.5 cm) might result from complications of developmental dysplasia of the hip and these patients can be treated with a percutaneous epiphysiodesis. © 2008 Lippincott Williams & Wilkins, Inc.

PubMed: 26422349 Objective: Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. The most common complaints due to this condition are inability to walk, delayed walking, and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity. Methods: Fourteen knees of 9 patients operated on by a single surgeon between 2009-2012 were included in the study. The tensor fascia was divided into 2 strips, and these strips were passed via the joint and sutured to themselves. The combined procedure additionally includes lateral capsular release, vastus lateralis (VL) resection, medial capsular plication, and Z-plasty of the rectus femoris (RF) tendon. Results: Mean age at the time of surgery was 6.9±3.3 years (range: 4-13 years). The mean follow-up was 37.6±0.9 months (range: 26-49 months). Patellofemoral instability was restored for all patients by using combined surgical technique. Patellar lateralization developed in 2 patients, in whom stability was obtained via secondary medial plication. Conclusion: Our results show that this combined surgical procedure stabilizes the knee and treats patellar dislocation accompanying ligamentous laxity in pediatric patients. © 2015 Turkish Association of Orthopaedics and Traumatology.

Surgical excision of the ossicles has been suggested for unresolved sequelae of Osgood-Schlatter disease in adults resistant to conservative measures. A 24-year-old, male semiprofessional soccer player had anterior knee pain during sports activity and climbing stairs that had been treated conservatively for 2 years. On physical examination, there was a permanent tibial tubercle with pain. On radiographic examination, an ununited ossicle was seen beneath the patellar tendon. Arthroscopy was performed through the standard low anterolateral and anteromedial portals close to the patellar tendon. Soft tissue at the retropatellar surface and the inflamed infrapatellar fat pad beneath the patellar tendon were debrided with a motorized shaver. Localization of the ununited ossicle was performed by use of an image intensifier. The ossicle was separated from the surrounding soft tissue with a motorized shaver and removed by use of a grasper. After excision of the ossicle, the inflamed surface of the retropatellar tendon was also debrided. The contouring of the irregular surface of the tibial tubercle was performed by use of a motorized bur. After 6 weeks, the patient returned to sports activities without any restrictions. This study showed that all of the described procedures might be done arthroscopically and sports activity may be allowed earlier. © 2008 Arthroscopy Association of North America.

Rotational deformities are common lower extremity abnormalities in children with cerebral palsy, which include intoeing and outtoeing. Intoeing is caused by one of the three types of deformity: increased femoral anteversion, internal tibial torsion, and metatarsus varus, while out-toeing, the less common form, is caused by femoral retroversion and external tibial torsion. An accurate diagnosis should be made with careful physical and radiographic examination., Rotasyonel deformiteler beyin felçli çocuklarda yaygın olarak görülen, içe dönük ve dışa dönük yürümeyi içeren alt ekstremite anormallikleridir. İçe dönük yürüme üç tür deformitenin birinden kaynaklanır: artmış femoral anteversiyon, internal tibial torsiyon ve metatarsus varus; daha nadir görülen dışa dönük yürüme ise femoral retroversiyon ve eksternal tibial torsiyondan kaynaklanır. Dikkatli fizik ve radyografik inceleme ile doğru tanı konmalıdır.

Intraosseous lipoma is among rare benign tumors of the bone. The aim of the present study was to evaluate the long-term surgical results of calcaneal lipomas, representing a relatively rare localization for this type of tumors. The present study included 21 calcaneal lipoma cases (22 feet) referred to our podiatry clinic between 1991 and 2001 with complaints of foot and heel pain resistant to conservative treatment for the last 3-6 months. In all cases, the diagnosis of calcaneal intraosseous lipoma was first confirmed radiologically, then histologically. The mean age was 39 years (range 16-62), 15 were females (71%) and 6 were males (29%). One patient had bilateral disease, whereas 11 and 9 patients had right and left calcaneal involvement, respectively. None of the patients have a palpable mass in their foot. For pre-operative differential diagnosis, 3 patients had computerized tomography examination (CT scan) and 8 patients underwent magnetic resonance imaging (MRI). All lesions were totally curetted out with angled curettes. The defect was filled with cancellous autografts taken from the ipsilateral iliac crest. In only four patients, the amount of autograft was not sufficient, so a combination of cancellous allograft and autograft was used. No drain was used. An elastic bandage was wrapped around the foot and ankle, and cold packs were applied to the surgical site. The mean duration of follow up was 94 (45-143) months. Pain improved in 17 feet at 4 months, in an additional 4 feet at 8 months and in the remaining one foot at 12 months. The mean time to the graft consolidation was 5 months (range 3-7 months). There were no recurrences or pathological fractures during the follow up. No wound infection or necrosis was seen at the surgical sites. There were no neurovascular complications. Five cases experienced pain in the iliac bone for 1 month, due to grafting procedures. Although calcaneal intraosseous lipoma accounts for a small portion of cases in the huge differential diagnosis chart for foot pain, it should be kept in mind as a possible diagnosis in unresolved cases. Most of the patients would benefit from non-surgical treatments. But if this is not the case, surgical treatment is indicated. In conclusion, curettage and autogenous bone grafting is an easy and effective method for the surgical treatment of calcaneal intraosseous lipomas. © 2009 Elsevier Ltd. All rights reserved.

Periacetabular osteotomy has been recommended for reconstructing symptomatic dysplastic hips in adolescents and young adults, but requires substantial incisions and exposure. To minimize large incisions, we asked whether periacetabular osteotomy could be performed with a mini-incision under direct endoscopic control. We used five fresh-frozen cadaver pelves and developed curved guides and osteotomes for the osteotomy. We were able to perform a periacetabular osteotomy under endoscopic and image intensifier control and to fix the osteotomy with two cannulated screws. We identified no damage to vital structures or intraarticular fracture in any of the five cadavers we subsequently dissected. We believe periacetabular osteotomy may be performed with a mini-incision under direct endoscopic control. Our preliminary observations suggest the approach might be explored in limited prospective clinical trials by experienced individuals. © 2008 The Association of Bone and Joint Surgeons.

Introduction: The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of type IIIA open fractures of the tibia. Materials and Methods: Sixty-one patients with open type IIIA tibial shaft fractures were treated with an IEF (n = 32) or UTN (n = 29). Both groups were compared for union time, secondary outcomes of nonunion, infections, mechanical failure of the implant, and malunion. Results: The average time-to-bone healing was 19 weeks (range 14-23 weeks) for IEF and 21 weeks (range 16-36 weeks) for UTN; it was significantly shorter in the IEF group (P = 0.039). One patient had refracture in the IEF group. Malunion occurred in four patients for each group. Posttraumatic osteomyelitis occurred in two patients in the IEF group and in three patients in the UTN group. In the IEF group, additional surgical procedures were indicated in three cases including sequestrectomy (n = 1), and pin replacement (n = 2). In the UTN group, seven patients needed additional surgery including bone grafting (n = 3), nail exchanged (n = 1), and posttraumatic osteomyelitis (n = 3). Conclusion: The results of the current study showed that IEF technique had a notable incidence of pin-tract infection, joint contracture, and shorthening related to treatment of the delayed union. The UTN technique had the disadvantage of a posttraumatic osteomyelitis and delayed union requiring additional surgery. We believe that the decision to use IEF or UTN should be made on a case-by-case basis. © Springer-Verlag 2007.