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Complex reconstruction after calcaneal excision for aggressive or malignant tumors has been advocated. In this report we describe a 7-year-old child who underwent chemotherapy followed by total calcanectomy for a primitive neuroectodermal tumor of the calcaneum. The near-normal function achieved after the operation leads us to believe that complex reconstruction after calcaneal excision is not warranted in every pediatric case. This report also highlights the benefits of the Cincinnati incision for calcanectomy, and describes the gait abnormalities after the operation. To the best of our knowledge, a description of the gait abnormality observed after calcanectomy for tumor resection in a pediatric patient has not been reported up to now.

Benign tumors of the calcaneum are rare. Cystic lesions such as simple bone cysts and aneurysmal bone cysts are commonly seen. Aims and Objectives: To evaluate tumors of the calcaneum, which were seen over a 12-year period. Materials and Methods: We analyzed noninfectious, noninflammatory, benign lesions of the calcaneum seen in the Orthopedic Out Patient Department from 1991 to 2003. Twelve such tumors were encountered. There were 11 males and one female and their ages varied from 18 to 53 years with a median of 31. Data was collected from the histopathology reports, radiographs, and inpatient and outpatient records. One of the coauthors reviewed the histopathologic findings of all the tumors. Results: Twelve benign lesions were seen in 12 patients. In our series, cysts predominated, with three aneurysmal bone cysts and five simple bone cysts. The other benign tumors were: one fibrous dysplasia, one vascular hamartoma, one osteoblastoma, and one chondromyxoid fibroma. The bone cysts were treated by curettage, with or without bone grafting, except for one large aneurysmal bone cyst, which was treated by excision of the calcaneum. The postoperative function in this patient was good, with modified footwear. Conclusion: The calcaneum is an uncommon site for most bone tumors, and in our series, bone cysts were the most common benign lesions. Curettage and bone grafting or the use of bone substitutes can be effectively used in the treatment of symptomatic bone cysts of the calcaneum.

We report a chondromyxoid fibroma of the proximal phalanx of the left third toe in a 35 year old woman, a rare site for this tumor. The radiological appearance of a trabeculated lytic lesion with sclerotic margins and soft tissue extension raised the possibility of other entities such as intraosseous epidermoid cyst, aneurysmal bone cyst, chondroblastoma, osteoid osteoma and chondrosarcoma as well as infections like pyogenic, tuberculous and leprous dactylitis. However the typical microscopic picture of lobules of cartilage separated by fibrocellular tissue and scattered osteoclasts confirmed the diagnosis. The tumor was successfully treated by curettage and bone grafting using a dorsal and plantar 2 incision technique and has no recurrence at 4 year follow up. In this article we present our experience with this case and discuss the differential diagnosis of a solitary lytic lesion in the phalanges of the toes.

The purpose of this study was to determine the talar facet configuration of South Indian calcanei, measure the angle between the anterior and middle facet planes of these calcanei, and assess the relation between the above parameters and the degenerative changes in the subtalar joints. The angle between the anterior and middle talar facets was measured in 222 South Indian adult calcanei. The degree of sclerosis was measured on radiographs of the calcanei. Lipping and osteophytes around the joints were recorded by visual inspection. The facet patterns observed were fused anterior and middle facets (Type I), three separate facets (Type II), absence of the anterior facet (Type III), three merged facets (Type IV), and a new pattern of absent anterior and fused middle and posterior facets (Type V). An anterolateral impression was present in nine calcanei. Type I was the predominant pattern (72%). Type II configuration had the least mean angle (125 degrees) and had less number of calcanei with significant osteoarthritic changes. A wider angle was observed in Type I and Type III calcanei. Type IV and Type V were observed in only three and one calcanei, respectively. Lipping and osteophytes were observed in Type I to IV configurations. There was no correlation between the facet configuration and the radiological subchondral sclerosis in the posterior talar facet of the calcanei. This study reveals that the talar facet configuration of calcanei and the angle between the anterior and middle facets influence the stability of the subtalar joints and development of osteoarthritis.

The clinical, radiological and pathological features of a case of lipofibromatosis, a rare paediatric soft tissue neoplasm, are described. The tumour involved the foot of a male infant and was present at birth. Magnetic resonance imaging showed a lipomatous mass, with splaying of muscles of the sole by lobules of fat. Histopathological examination revealed typical findings of an admixture of mature adipose tissue and fibroblastic elements. The radiological and pathological features helpful in differentiating this entity from other fibro-fatty paediatric soft tissue tumours is discussed, and the relevant literature is briefly reviewed.

Purpose Release of the psoas tendon for flexion deformity of the hip in children with cerebral palsy has traditionally been performed at the pelvic brim, lateral to the neurovascular bundle, or at its insertion into the lesser trochanter. As the psoas tendon is lateral to the pectineus, the traditional exposure of the tendon through an approach medial to the pectineus is limited by the extent to which the pectineus can be retracted proximally. Technical note We describe the use of the anteromedial approach used for the developmentally dislocated hip to expose the psoas tendon between the pectineus and the neurovascular bundle. This provides a much better visualisation of the tendon as it crosses the superior pubic ramus to its insertion. The use of this approach has not been described in cerebral palsy.

Case: We report a case of heterozygous mutation of c.-14C>T in the 5′-untranslated region of the interferon-induced transmembrane protein 5 in a nine-year-old girl. She was diagnosed with type-V osteogenesis imperfecta based on the classic features of bone fragility, radial head dislocation, forearm interosseous membrane calcification, limited forearm rotation, hyperplastic callus formation, and radiodense metaphyseal bands, as well as absent blue sclerae, absence of hearing loss, and absence of dentinogenesis imperfecta. Conclusion: Although the differential diagnosis may include infantile cortical hypertrophy, child abuse, or a malignant tumor (e.g., osteosarcoma), the presence of typical clinical and radiographic features and characteristic gene mutation helps confirm the diagnosis of type-V osteogenesis imperfecta.

A case of severe post burns contracture of the wrist, of 43 years duration resulting in recurrent ulceration of the skin was successfully treated by gradual distraction using the Ilizarov method. This method is superior to plaster of Paris cast and is more versatile than other forms of external fixation.