Bony Growth Research Articles

Remoção de Grande Toro Palatino: Relato de Caso

Torus are benign bony growths commonly found in the mouth, particularly on the hard palate, maxilla, and in the vestibular or palatine region of the alveolar process, or on the lingual aspect of the mandible above the mylohyoid line. They are more common in women and individuals of Asian descent. The clinical case presented here illustrates the removal of a large lobular palatal torus in a 67-year-old male patient, performed in an outpatient setting. The surgical access was achieved through a mucoperiosteal flap in a "Y" shape due to the extension towards the posterior region. After the removal of the exostosis, suturing was performed with the placement of a surgical drain. Fifteen days post-surgery, the patient showed no signs of tissue necrosis.

Reliability assessment of new radiographic scales to evaluate radiolucency and bony in-between fin growth of partially cemented all-polyethylene glenoid components

Current methods available for assessment of radiolucency and in-between fin (IBF) growth of a glenoid component have not undergone interobserver reliability testing for an all-polyethylene fluted central peg (FCP) glenoid. The purpose of this study was to evaluate anteroposterior radiographs of an FCP glenoid component at ≥48 months comparing commonly used scales to a new method adapted to the FCP. Our hypothesis was that the new method would result in acceptable intra- and interobserver agreement and a more accurate description of radiographic findings. We reviewed ≥48-month follow-up radiographs of patients treated with a primary aTSA using an FCP glenoid. Eighty-three patients were included in the review. Radiographs were evaluated by 5 reviewers using novel IBF radiodensity and radiolucency assessments and the Wirth and Lazarus methods. To assess intraobserver reliability, a subset of 40 images was reviewed. Kappa statistics were calculated to determine intra- and interobserver reliability; correlations were assessed using Pearson correlation. Interobserver agreement (κ score) was as follows: IBF 0.71, radiolucency 0.68, Wirth 0.48, and Lazarus 0.22. Intraobserver agreement ranges were as follows: IBF radiodensity 0.36-0.67, radiolucency 0.55-0.62, Wirth 0.11-0.73, and Lazarus 0.04-0.46. Correlation analysis revealed the following: IBF to Wirth r=0.93, radiolucency to Lazarus r=0.92 (P value <.001 for all). This study introduces a radiographic assessment method developed specifically for an FCP glenoid component. Results show high interobserver and acceptable intraobserver reliability for the method presented in this study. The new scales provide a more accurate description of radiographic findings, helping to identify glenoid components that may be at risk for loosening.

Pediatric Maxilla-Mandible Oncoplastic Reconstruction: A 25 Patient Case Series

Objective: We present a case series of 25 pediatric patients who underwent maxillary and mandibular oncoplastic reconstruction at a single institution. Further, we discussed the present review of the literature and underscored the unique considerations for the pediatric population. Methods: A retrospective chart review of 25 pediatric oncoplastic patients undergoing maxillary and/or mandibular reconstruction was performed from March 2015 to January 2022. Results: Thirteen patients underwent maxillary reconstruction, and 12 patients underwent mandibular reconstruction. The mean age of the maxillary cohort was 10.2 years, and the mean age of the mandibular cohort was 9.8 years. The age range of patients followed was from 6 months to 18.8 years. All patients displayed satisfactory postoperative swallowing and facial symmetry at subsequent follow-up visits. Conclusion: Maxillary and mandibular reconstruction following oncologic resection requires special attention in the pediatric population because of the difficulty to predict bony growth of the mid and lower face, and the resultant effects on dentition and symmetry. Our case series demonstrates successful pediatric maxillomandibular reconstruction utilizing microvascular free tissue transfer and 3D virtual surgical planning.

Does the Sleeper Plate Application for Temporary Epiphysiodesis Make Life Easier or Complicated? Increased Risk of Tethering.

The present study aims to investigate the frequency of recurrence and tethering effect after only metaphyseal screw removal (sleeper plate technique) compared with the conventional complete plate removal in the treatment of lower extremity deformities with guided growth surgery. Seventy-two patients (107 limbs) treated by an 8-plate hemiepiphysiodesis technique around the knee joint were evaluated. After the desired correction, only metaphyseal screw was removed (sleeper plate group) in 35 limbs (25 patients), whereas both screws and plate were removed (plate removal group) in 72 limbs (47 patients). An increase of 5 degrees or more in joint orientation angles in the direction of the initial deformity was considered as recurrence. The rate of rebound, tethering, and maintenance of correction in groups was analyzed at the latest follow-up (mean of 49mo). The mean age of the patients was 97 months (range: 80 to 129mo) at the time of index surgery. After a mean of 49 months (range: 16 to 86), 17 (48.5%) limbs maintained the desired stable correction in the sleeper plate group compared with 59 stable limbs (72.2%) in the plate removal group ( P <0.001). There was no statistically significant difference regarding recurrence between the sleeper plate group and the plate removal group (34.3% vs. 27.8%, respectively) ( P =0.216). Reinsertion of the metaphyseal screw was possible 8/12 limbs, and the remaining 4 limbs underwent further surgeries. There were 6 limbs (17.3%) of tethering in the sleeper plate group, and 4/6 limbs required further corrective surgeries. The remaining 2 limbs with slight tethering did not require further surgeries. Removing only metaphyseal screw increases the risk of tethering. In addition, reinsertion of the screw may not be possible in all cases due to bony growth, and further corrective surgeries may be necessary. Close follow-up is required if the sleeper plate technique is to be applied. Level III.

Morphological Measurements of Innominate Foramina and Bony Spurs along the Base of Sphenoid as a Potential Risk Factor for Neurovascular Entrapment, Radiological Interpretation and Surgical Access.

Restricted access and compression of neurovascular structures at various anatomic variations at the skull base poses a challenge to surgeons, neurologists and anesthetists. The present study was performed with the objective of providing morphometric analysis of innominate foramina, and anomalous bony bars and spurs along the infratemporal surface of the greater wing of the sphenoid and reviewing the practical significance of dealing with this region. A total of 100 dry-aged human adult skulls from the archives of the osteology library of the Department of Anatomy were studied. A detailed morphometric analysis of such innominate foramina and anomalous osseous structures along the base of the sphenoid was performed using a sliding digital vernier caliper. Anomalous bony bar was found in 22 skulls (25.28%). A complete bar was observed at eight (9.1%). An innominate foramen was located inferomedial to foramen ovale (5 unilateral and 3 bilateral) with a mean anteroposterior diameter of 3.44 mm and a mean transverse diameter of 3.16 mm. Neurovascular structures may be compressed by abnormal bony outgrowths or while traversing through such unnamed bony foramina. The latter may also be overlooked and mistaken during radiological interpretation leading to delayed diagnosis. Such unnamed foramina and bony outgrowths need to be documented in the literature due to their surgical, and radiological implications and limited citations.

Chondrosarcoma in a Patient with Multiple Osteochondromatosis: A Case Report and Review of the Literature

Hereditary multiple osteochondromas (HMO) is an autosomal dominant disease diagnosed by the presence of two or more than two osteochondromas on radiographs. The majority of cases are asymptomatic. The presence of bony growth, pain, and compression of the surrounding structure are the usual presentations. Malignant transformation into chondrosarcoma is the most feared complication. A rapid increase in size, recurrence after the surgical excision, and infiltrating mass may suggest the conversion into chondrosarcoma. Radiological imaging helps in diagnosing malignant transformation. MRI is the investigation of choice to exclude cancer. We here by present a case of multiple osteochondromas with suspected malignant transformation due to rapidly increasing painful osseous swelling.

Morpho-radiological and brain endocast analysis in the study of Hyperostosis Frontalis Interna (HFI): A combined approach.

The purpose of this study is to anatomically evaluate the impact on the patient intra vitam of an endocranial condition on a late 20th century skull housed in the Section of Legal Medicine of the University of Foggia (Foggia, Apulia, Italy). After performing a retrospective diagnosis, the condition is framed in the broader context of studies on this pathology. An anthropological and radiological analysis (X-ray and CT scan imaging) made it possible to confirm the preliminary information and to detail the osteological diagnosis of HFI. In order to assess the impact on the cerebral surface of the endocranial growth a 3D endocast was obtained using the Software OrtogOnBlender. The skull is demonstrated to have belonged to a female senile individual known, from limited documentary evidence, to have suffered from a psychiatric condition during her life. The final diagnosis is hyperostosis frontalis interna (HFI), Type D. Although a direct correlation between the demonstrated intracranial bony growth and the onset of the patient's psychiatric condition is difficult to retrospectively ascertain, the pressure exerted on this female individual's frontal lobe may have contributed to further degenerative behavioural changes in the last years of her life. This case adds to previous knowledge, especially from the palaeopathological literature, on this condition and, for the first time, presents a neuroanatomical approach to assess the global impact of the disease.

Morphological variations and morphometry details of the foramen ovale in the Saudi population: a retrospective radiological study.

The foramen ovale is one of the essential foramina in the middle cranial fossa, more precisely, in the superior surface of the greater wing of the sphenoid bone. It has essential surgical and diagnostic significance since it serves as a surgical landmark, and crucial neurovascular vessels such as the mandibular nerve and accessory meningeal artery pass through it. Therefore, understanding the morphological and morphometric variations of the foramen ovale is essential for accurately identifying, diagnosing, and managing related pathologies. The study aimed to evaluate the morphological variations and morphometric details of the foramen ovale in the Saudi population. A radiological study was conducted to observe the measurements and the shapes of the foramen ovale in the skull with its anatomical variants. Retrospective data was collected from the Department of Radiology, King Fahad University Hospital, Saudi Arabia. The sample consisted of 100 human skulls from computed tomography scans, including 50 males and 50 females. The values for the mean length, width, and distance from the midline on the right side were 6.462 mm ± 1.681 mm, 4.897 ± 1.0631 mm, and 2.4565 ± 0.51275 mm, and 6.451 ± 1.6691 mm, 4.812 ± 1.0848 mm and 2.4290 ± 0.60039 mm for the left side, respectively. The foramen shape was oval in the majority (47%), followed by round shape (31%) with no bony outgrowths such as spur in the studied foramina. Furthermore, the morphometric variation between males and females was statistically insignificant (p-value>0.05). The observed variation of foramen ovale in this study has significant anatomical and clinical applications for various diagnostic and surgical procedures.

A RETROSPECTIVE COMPARISON OF CAGE-ALONE VERSUS CAGE-PLATE CONSTRUCTS USED IN ANTERIOR CERVICAL DISCECTOMY AND FUSION

Anterior cervical discectomy and fusion (ACDF) is a well-established spinal operation for cervical disc degeneration disease with neurological compromise. The procedure involves an anterior approach to the cervical spine with discectomy to relieve the pressure on the impinged spinal cord to slow disease progression. The prosthetic cage replaces the disc and can be inserted stand-alone or with an anterior plate that provides additional stability. The literature demonstrates that the cage-alone (CA) is given preference over the cage-plate (CP) technique due to better clinical outcomes, reduced operation time and resultant morbidity. This retrospective case-controlled study compared CA versus CP fixation used in single and multilevel anterior cervical discectomy and fusion for myelopathy in a tertiary centre in Wales.A retrospective clinico-radiological analysis was undertaken, following ACDF procedures over seven years in a single tertiary centre. Inclusion criteria were patients over 18 years of age with cervical myelopathy who had at least six-month follow-up data. SPSS was used to identify any statistically significant difference between both groups. The data were analysed to evaluate the consistency of our findings in comparison to published literature.Eighty-six patients formed the study cohort; 28 [33%] underwent ACDF with CA and 58 [67%] with CP. The patient demographics were similar in both groups, and fusion was observed in all individuals. There was no statistical difference between the two constructs when assessing subsidence, clinical complication (dysphagia, dysphonia, infection), radiological parameters and reoperations. However, a more significant percentage [43% v 61%] of patients improved their cervical lordosis angle with CP treatment. Furthermore, the study yielded that surgery to upper cervical levels results in a higher incidence of dysphagia [65% v 35%]. Finally, bony growth across the cage was observed on X-ray in 12[43%] patients, a unique finding not mentioned in the literature previously.Our study demonstrates no overall difference between the two groups, and we recommend careful consideration of individual patient factors when deciding what construct to choose.

Acquired Spur-Like Bony Growth Over the Previous Fibulectomy Site Following the Management of Both Bone Leg Fracture Nonunion: A Case Report

Abstract Exophytic bony outgrowths have many differential diagnoses, with osteochondroma being the most common. The de novo development of a well-defined bony growth over the location of a previous surgery is a rare occurrence. Here, we describe a case of gradual development of a small bony exophytic lesion over the fibula diaphysis as a delayed complication of the previous fibulectomy. The index surgical procedure of fibulectomy was coupled with bone grafting at the tibial nonunion site following failed conservative management of the tibia fracture. The tibia fracture eventually united after the bone graft procedure. However, there was a gradual development of the aforementioned bony outgrowth noted in serial radiographs at the site of the previous fibulectomy. The growing lesion was also palpable on deep palpation over the corresponding site, and the excision of the lesion revealed a solid bony mass. Histopathology showed the lesion to be composed of mature bony tissue without any evidence of a cartilage cap. No recurrence or complication was noted in the fourteen-month follow-up. The diagnosis of an acquired exostosis was established based on clinical, radiological, and histopathological evaluation.

A rare case of ribbing disease of the proximal tibia

&lt;p&gt;Ribbing disease is a rare disease that causes bony growths to develop in long bones mostly the lower limbs. It often develops after puberty. The disease also goes by other names like multiple diaphyseal sclerosis. The disorder is caused by discrepancy in the osteoclast regulation process. Here in we report a 28 years old male presenting with a case of ribbing disease of right proximal tibia. A 28 years old male gives history of fall when he was 6 years old i. e., 22 years back. Now patient complaints of pain in right proximal tibia since last 6 months. Pain is of mild nature. It is most likely a case of ribbing disease based on the clinical, radiological findings. Ribbing disease is a disease of exclusion, needs high degree of suspicion for its diagnosis. However, patient should be advised for regular follow ups.&lt;/p&gt;

Occipital spur: an incidental finding on a diagnostic cone-beam computed tomography – a case report

Exaggerated bony outgrowth of the external occipital protuberance is called occipital spur. The current report presents a case of a 20-year-old male patient seeking orthodontic treatment. The patient was referred for a cone-beam computed tomography scan to determine the position of impacted maxillary canines. An incidental finding on the scan was the existence of a focal spine-like hyperostosis in the occipital protuberance, and confirmed to be an occipital spur (Type III spine form). Clinical examination showed a palpable bone swelling without any tenderness, infection or discharge. He was referred to an orthopaedic surgeon should any symptoms get aggravated in the future. This case supports the essential role of cone-beam computed tomography to detect, analyse and identify the lesion as an occipital spur. This is the first such case report of its kind, which measures the size of occipital spur using cone-beam computed tomography and 3D imaging software. Usually asymptomatic, awareness of this uncommon presentation can expedite emergency medical care in the event of pain, or trauma leading to fracture or avulsion of the spur fragment. In such an event, the readily available CBCT data will be indispensable to surgeons for planning surgery with precise linear and volumetric measurements. Knowledge of these bony spurs is of untold value to anatomists, who will benefit greatly from being able to study the variants in vivo, in addition to studies on dry skulls or preserved cadavers. It is also of interest to clinicians and radiologists for diagnostic purposes, and sports physicians.

Study of calcaneal spur and its correlation with the talar articular facets of calcanei

Background &amp; aims: A spur is bony outgrowth at the site of attachment of a ligament or tendon into bone. The aim of this study is to analyse the incidence of calcaneal spur in relation to morphological variations of talar articular facets of calcaneus. Material &amp; Method: Study comprised of 350 dry adult calcanei of unknown age and sex from Department of Anatomy, B. J. Medical College, Ahmedabad. Calcanei were classified according to its talar articular facets and compare its relation with the calcaneal spur. Result: Out of the 350 calcanei 128 presented with spurs among them planter spur in 21.4%; dorsal spur in 10.2% and both spurs in 4.8%. Maximum incidence of calcaneal spurs were found in Type 1 calcanei 75% followed by 17.96% in Type 2, 7% in Type 3 and 0.7% in type 4. Conclusion: Calcaneal spurs are related to type of calcanei with the highest frequency in Type 1 and least in Type 4. Anatomical knowledge of the correlation between calcaneal spur and type of calcaneus may be of significant clinical interest to foot and ankle surgeons in clinical practice. Keywords: Dorsal spur, plantar spur, talar articular facets.

CLINICAL AND RADIOLOGICAL PARALLELS IN DIAGNOSIS OF DISEASES AND DYSFUNCTION OF TEMPOROMANDIBULAR JOINT

Introduction. Dysfunction of the temporomandibular joint is a rather widespread disorder and occupies a leading place among all other joint disorders.&#x0D; Subjects and methods. The study was conducted at the Department of Propaedeutics of Surgical Dentistry. 10 people with clinical signs of temporomandibular joint (TMJ) dysfunction were selected, and subjected to radiological and magnetic resonance imaging in order to clarify the final diagnosis.&#x0D; Results and discussion. The main criterion for magnetic resonance imaging diagnostics in dysfunctional TMJ conditions is visualization of the intra-articular cartilage disc.&#x0D; When comparing radiograms and magnetic resonance imaging, the main criteria were:&#x0D; &#x0D; Distortion between research methods;&#x0D; The presence of any bone formation and its importance in making a diagnosis. Comparing the series of radiograms and magnetic resonance imagings shows the distortion of the imaging results. In four patients, radiograms showed narrowing of the joint space in the anterior-posterior sections, but this did not occur on magnetic resonance imaging. In this case, patients should feel pain irradiating to the ear. This option is possible due to compression of the bilaminar zone, where the auriculotemporal nerve is located. Characteristic pathological symptoms were determined in one patient out of four that prompts the question about the correctness of determining the joint space on a series of radiograms. In these research methods, the following features were common: 1. The articular head was flattened (4 patients), had a dumbbell-like shape (6 patients). 2. With the mouth open, attention was drawn to the placement of the articular head in relation to the articular tubercle. Subluxation of one of the joints was found 8 patients; joint hypermobility was detected in 2 patients. Magnetic resonance imaging of the TMJ joint in 3 patients showed anatomical instability, namely degenerative changes in the articular discs, and bony growths. Degenerative changes of the meniscus did not occur in the other 7 patients.&#x0D; &#x0D; Conclusion. Undoubtedly, the best diagnosis when choosing the right method is based on the doctor's experience in correct image interpreting. Radiogram is a relatively cheap method compared to magnetic resonance imaging, but it is far from being exceptionally effective because it does not visualize the connective tissue elements of the joint. Magnetic resonance imaging fully characterizes all bone and soft tissue elements that helps the doctor to clearly determine the final diagnosis based on which the treatment plan will be made up.

Evaluation of Differences between the Baltic Triglopsis quadricornis and White Sea Triglopsis sp. Using Morphological and Genetic Data

According to the modern fish system, one species of fourhorn sculpin Triglopsis quadricornis lives in the Baltic Sea and Arctic waters. In the present study, sculpins from the Baltic and White Seas were studied using different methods: morphological analysis to establish patterns of the seismosensory system, tomography for the study of cranial bones, X-ray imaging for the study of the axial skeleton, as well as phylogenetic analysis of two mtDNA markers (control region and CO1) and one nDNA marker (RAG1). The results obtained by these methods were used to prove the existence of two species: T. quadricornis in the Baltic Sea and Triglopsis sp. in the White Sea. These species differ significantly in the unique shape and size of the bony outgrowths on the head, as well as in the number of bony plates on the body. Genetic differences between the species were expressed in the formation of T. quadricornis and Triglopsis sp. independent clusters on Bayesian phylogenetic trees reconstructed based on the sequences of the mtDNA control region and RAG1.

Comprehensive Ayurvedic Management of Calcaneus Spur- A Single Case Study

Agnikarma is an important para-surgical procedures mentioned in Ayurveda. It has emerged as integral part of the Ayurvedic therapeutics. Agnikarma is a thermal and minimally invasive procedure that induces controlled, pointed and therapeutic burns over the regions that are tender or painful. Acharya Sushruta has advised Agnikarma for Snayugata Vata and Asthigata Vata. Painful heel due to prolonged standing is relatively common foot problem in modern era and predominant cause of such pain is calcaneal spur. The calcaneal spur is a condition of pointed bony outgrowth of heel bone. Usually, it affects people day to day routine life and once manifested it becomes difficult to cure. It is caused due to deposition of calcium on underside of heel bone over a prolonged period of time. It is diagnosed by the radio-logical examination (X-RAY). As far as modern medicine is concerned there is no safe and cost-effective treatment available of calcaneus spur. Pharmacological treatment used are NSAID’s, analgesic drugs, steroid injections, and exercises. The surgical treatment is release of plantar fascia and excision of calcaneus spur but complications are incomplete relief of pain and nerve damage. In Ayurveda Agnikarma is one of the competent treatments of calcaneus spur. Agnikarma is carried with special instrument called Pancha Dhatu Shalaka. This Shalaka is made up of five metals (Copper, Iron, Zinc, Silver and Gold). A patient successfully treated with Agnikarma therapy is presented in this case study

Comparative clinical and morphometric investigations of cervical stenosis of the spinal canal in humans and dogs

Acquired stenosis of the spinal canal is a common problem in human and animal pathology. It is defined as a pathological condition that mainly develops as degeneration of the spine with cervical myelopathy development, which is a characteristic manifestation of this pathology. Pain both in the neck and upper back is the leading syndrome of this pathology. 65 human patients aged 20–65 years and 19 dogs weighing more than 20 kg were examined with the aim of comparative clinical and morphometric analysis of stenosis of the spinal canal. The age of the dogs was maximally converted to the age of a person. Computed tomography using the Pavlov-Torg index and the reserve space evaluation supplemented diagnosis of stenosis of the spinal canal. The mass proportion of stenotic changes of the spinal canal against the background of the degenerative-dystrophic process was 21 in males (n = 25) 84.0%, females – 28 persons (n = 40) 70.0%. Pain syndrome was the main complaint in all patients. Cervicalgia prevailed in 60 (92.3%), pain in the upper back was registered in 32 (49.2%) patients. The intensity of pain syndrome was equal to 3.1 ± 0.4 points. Motor deficiency in the form of paresis, mainly of the distal parts of the hands, was registered in 48 patients (73.8%), pyramidal symptoms were noted in the legs in 32 (49.2%) patients, pelvic reservoir dysfunction (7.0–10.8%), and sensory disorders were also found (24.0–36.9%). Such manifestations of cervical myelopathy progressed slowly. Pyramidal symptoms were more frequent and more pronounced in men. According to the computed tomography scan, degenerative changes of the spine were maximal at the level of the C6 vertebra with the maximum clinical correlation (neurological deficit, pain syndrome, etc.). In the course of the research, probable stenosis of the spinal canal was found in people on computed tomography images. In the 19 dogs observed weighing 20 kg or more the presence of pain syndrome was evaluated in all the animals (100.0%) as well as behaviour change (100.0%). During the examination, gait disorder was detected (18.0–94.7%); reaction to palpation of the neck area (15.0–78.9%); the habitus of animals experiencing pain, especially during neck movements (14.0–73.7%), body tension (12.0–63.1%), etc. Bony outgrowths of the edges of the vertebrae and intervertebral joints were found in almost all dogs of 18 (94.7%) large breeds compared to others. Narrowing of the intervertebral openings, deformation and sclerotic changes of the locking plates, thickening of the yellow and elongated ligaments occurred three to four times more in large breeds compared to dogs weighing less than 20 kg, and were absent in cats. Stenosis of the spinal canal was detected in 15 (78.9%) dogs. Therefore, acquired stenosis of the spinal canal probably develops after degenerative-dystrophic changes in the neck in 87.7% of people and in 78.9% of dogs with clinical manifestations of cervical myelopathy and with persistent pain syndrome (equal to 3.1 ± 0.3 points in humans and 2.6 ± 0.4 points in animals according to visual analog scale). This kind of pathological process in the investigated groups developed mainly at the level of the C6 vertebra. Similar clinical and morphometric indexes were obtained in humans (87.7%). It was found that the maximum similarity of pathological processes with stenosis of the spinal canal formation was characteristic in dogs of exclusively large breeds. Therefore, we consider it promising to study the development mechanisms of stenosis of the spinal canal and peculiarities primarily in young generations of humans and animals, to implement modern non-invasive neuroimaging methods, in particular for animals with investigation of morphometric indexes. This will prevent the occurrence of most comorbid syndromes, including chronic pain, neurological deficits as well as help find new opportunities for correction of stenosis of the spinal canal, to suppress the aging processes not only of the muscle-skeletal system but also of the body as a whole. The importance of this work, we suppose, lies in the further identification of adequate models in animals of different breeds and weight categories with stenosis of the spinal canal pathology in which it develops significantly faster, for extrapolation to humans to predict the development of pathological events.

Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial

BackroundCalcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression.ObjectiveInvestigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur.MethodsDesign: A single-blinded, randomized and controlled trial. Setting: Biomechanics laboratory. Participants: Forty-three women, 29 with calcaneal spur and 14 control.InterventionGait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). Statistical analysis: analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen’s also was used between T0 and after six (T6) months of intervention.ResultsThe MFG and COIG were effective at reducing pain after six months (MFG: 2.5–4.5 CI, p = 0.001; COIG: 1.5–3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7–15.4 CI, p = 0.010; COIG: 11.3–15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3–622.7 CI) and COIG (401.3–644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2–5.4 CI; Left: 3.6–5.4 CI) COIG (FPI Right: 3.4–6.8 CI; Left: 3.3–5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG.ConclusionsThe mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects.Trial registrationClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).

Popliteal pseudoaneurysm secondary to osteochondroma of femur: Case report

An 18 year old boy with no significant trauma presented with gradually developing swelling over right knee for 2 years. Recently he started noticing increased in size of swelling with pulsatile swelling over right knee. X-ray showed pedunculated bony outgrowth from distal femur suggesting osteochondroma but pulsatile nature of swelling was not explained. CT angiogram and MRI was done which showed large popliteal pseudoaneurysm and a spiked bone tumor arising from distal femur. Popliteal pseudoaneurysm secondary to osteochondroma was suspected and open surgery was done with pseudoaneurysm excision and end to end repair with tumor excision. There was no signs of recurrence or neurovascular involvement in 2 years follow up. Although rare, popliteal pseudoaneurysm should be in surgeons differential in a case of painful knee swelling/ pulsatile mass in adolescent even without history of injury and timely intervention should be done to prevent irreversible damage.

Evaluation of Anterior Coverage in Children With Developmental Dysplasia of the Hip Using Transverse Magnetic Resonance Imaging at 2 Years Is Predictive of Future Radiographic Coverage.

Although normal anterior acetabular coverage provides stability to the hip, acetabular retroversion leads to femoroacetabular impingement related to hip osteoarthritis. Previous studies have focused on acetabular version and anteroposterior coverage in children with developmental dysplasia of the hip (DDH); however, the correlation between anteroposterior coverage and acetabular development is unclear. We measured anteroposterior acetabular coverage in DDH patients using transverse magnetic resonance imaging (MRI) and subsequent bony acetabular growth, and evaluated the correlation of those findings. We evaluated 37 DDH (dislocations) in 36 patients who underwent MRI at 2 years of age. The mean age was 2.2±0.3 years at the time of MRI (1.6±0.4y after reduction) and 6.0±0.1 years at the time of plain radiography for the Severin classification. On MRI scans, we measured the cartilaginous center-edge angle (CCEA) and cartilaginous acetabular-head index (CAHI) in the coronal plane and the anterior and posterior cartilaginous center-edge angles (AC-CEA and PC-CEA, respectively) in the transverse plane. Severin I or II was defined as a good outcome and III or IV as a poor outcome. In the evaluations conducted at 2 years of age, the mean CCEA, CAHI, AC-CEA, and PC-CEA were 14±9 degrees, 66%±10%, 39±8 degrees, and 77±7 degrees, respectively; the CEA at 6 years of age was 13±7 degrees. Twelve and 25 hips were classified in the good and poor outcome groups, respectively. Although CCEA, CAHI, and AC-CEA were significantly associated with the outcome in a single regression analysis ( P <0.05), only AC-CEA was significant in the multiple regression analysis with a stepwise selection method ( P =0.018). The cutoff AC-CEA value for a good outcome was 38 degrees (sensitivity, 67%; specificity, 68%) using a receiver operating characteristic curve. Among MRI findings for acetabular cartilaginous morphology, AC-CEA was strongly associated with the outcome. Anteroposterior coverage was correlated with bony acetabular growth in childhood, and anterior coverage was particularly important for subsequent acetabular growth. Level IV-case series.