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  • ISSN: 2373-9290
    Volume 3, Issue 3
    Review Article
    Najdi Hassan and Jawish Roger
    Abstract: Metatarsus adductus is a deformity at Lisfranc's joint in pure transverse plane. It is spontaneously corrected in few months for majority of newborns. In rare cases it demonstrates a clinical stiffness and it results in skewfoot (Z-shaped) in toddler, where valgus of heel creates equilibration of resistant metatarsus adductus. Although, recurrent metatarsus adductus varus is observed in treated idiopathic clubfeet, usually in children over three years, but valgus of the heel when exists is related to surgical overcorrection of heel's varus.
    Conservative treatment is advocated in flexible metatarsus adductus, considering manipulations, cast and adequate shoes. Surgery is performed in walking patient when conservative treatment failed. Procedures described in literature considering soft tissue releases, osteotomies of metatarsals and medial epiphysiodesis of metatarsal base gave good results in short term, but they could not avoid recurrence of the deformity and growth disturbance of the foot. Therefore, permanent correction has been obtained with osteotomy proximal to Lisfranc's joint. Surgical procedures going from opening wedge osteotomy of medial cuneiform, calcaneo-cuboid fusion and resection of anterior end of calcaneus, all act only on one of the sides of deformity. Combining opening wedge osteotomy of cuneiform with closing wedge osteotomy of cuboid described by Jawish allows in metatarsus adductus stiffness a lateral shifting of forefoot. Concerning the associated heel's valgus, it is thoroughly corrected in Z-shaped foot after double osteotomy cuneiform/cuboid. However, in clubfoot a particular treatment for the posterior tarsal is necessary, because valgus is considered a non-functional deformity related to imbalance at the rearfoot.
    John Mcmurtry*, Varatharaj Mounasamy
    Segmental fractures of the tibia present a challenge to treating orthopedic surgeons due to their infrequent presentation, wide zone of tissue injury, and increased rate of complications. The average union times range from 15 weeks to greater than 40 weeks with fractures demonstrating more delayed unions and nonunion in open injuries. Management primarily using a cast or brace, although infrequently used, is only indicated for low risk patients with a closed fracture, minimal shortening, and minimal angulation. Uni/multi planar external fixation, ringed external fixation, plate osteosynthesis, and Ender Nail placement are useful in selected clinical situations, but intramedullary nail placement represents the most common treatment strategy. Contention over the use of reamed versus unreamed locked intramedullary nails exists but the recommended treatment of closed segmentaltibial shaft fractures is with reamed locked intramedullary nailing. The recommended treatment of open segmental tibial shaft fractures is with unreamed locked intramedullary nailing to maximize fracture biology and to minimize risk of devascularization of the intercalary segment. Although treatment of segmental tibia fractures can be daunting excellent outcomes can be achieved with adherence to meticulous soft tissue management, optimalimplant choice, and close clinical follow up to minimize known complications.
    Research Article
    Sherif Naseef G. Bishay*
    Background: Hamstring muscles contracture is a major problem in the management of the cerebral palsy CP patient causing the crouch gait which is one of the most resistant conditions to treat.
    Methods: Twenty patients (40 knees) with spastic cerebral palsy diaplegia, between 7 - 12 years of age, presented to The National Institute of Neuromotor System of Egypt, from January 2010 to January 2011. All of the patients were diplegic and community ambulators but having knee flexion deformity and walking with crouch gait. All received previous conservative treatment for cerebral palsy in the form of muscle relaxants and physiotherapy, but no previous surgery. Ten were males and ten were females. All were evaluated clinically for the presence of spasticity and/or contracture, knee flexion deformity, popliteal angle, hip extension strength, and type of gait. All underwent lateral hamstring transfer around the proximal head of origin of gastrocnemius, as well as medial hamstring lengthening by Z-plasty and fractionally. Both knees of each patient were operated upon in the same sitting.
    Results: Clinical evaluation using a grading system revealed that 12 patients (60%) were classified as excellent, 6 patients (30%) as good, and 2 patients (10%) as fair. No poor cases were recorded. There was no complication. There was significant improvement in the result (p> 0.05).
    Conclusion: Transfer of the biceps tendon to just above the knee around the lateral head of origin of gastrocnemius, combined with appropriate Z-plasty lengthening of gracilis and semitendinosus tendons and fractional lengthening of semimembranosus being retained in position, is effective in relieving crouch gait in cerebral palsy with spastic diplegia.
    Level of Evidence: The study is type IV clinical evidence.
    Case Report
    El-Sayed M, Hosny G and Rizk O
    Abstract: Infantile myofibromatosis is considered as the most common fibrous tumor of infancy. Skeletal affection was reported in numerous articles. In this study we have treated two cases with severe tibial deformities using the Ilizarov frame. The Ilizarov was found useful in correction of the deformity as well as in limb length discrepancy management. Recurrence however, took place in one case and the resultant deformity was treated adequately using the Ilizarov frame. It was concluded that the Ilizarov frame was adequate for management of infantile myofibromatosis of the tibia for deformity correction and lengthening.
    Joerg Friesenbichler*, Werner Maurer-Ertl, Lukas Holzer, Christian Weger, Christoph Mueller, Reinhard Windhager and Andreas Leithner
    Abstract: Osteosarcoma and Ewing's sarcoma are the most common primary, non-haemopoietic malignant bone tumors in children and adolescents. However, they rarely occur in the calcaneus with only few cases reported in the literature. Below knee amputation is considered to be the standard treatment leading to good functional results. However, in some rare instances a calcanectomy alone is possible and reconstructive options have to be considered.
    Herein, we report a case of an 8-year-old boy with calcaneal Ewing's sarcoma, who presented with heel pain followed by swelling for more than one month. Following neo-adjuvant chemotherapy and preoperative radiation therapy a wide resection was performed. Reconstruction of the calcaneus was done using an allograft which got resorbed within two years of follow-up. The patient had no evidence of disease at a follow-up of 101 months.
    Reviewing the literature for similar cases or different reconstructive methods showed different treatment modalities for calcaneal malignancies besides below knee amputations such as custom made prosthesis, autograft- or allograft reconstruction or total calcanectomy.
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