Leg Deformities Research Articles

​Impact of Dietary Aflatoxin-B1 on Juvenile Growth in White Pekin Ducks

Background: Aflatoxicosis in ducks is reckoned as a challenge for nutritionists worldwide, for its adverse impacts on growth. A study was conducted to ascertain the precise level of Aflatoxin-tolerance in White Pekin ducklings during juvenile ages. Methods: Day-old-ducklings (240) were randomly distributed into 3 experimental-groups viz., Control ( less than 0.5 ppb), T1 (200 ppb), T2 (400 ppb) and reared for measuring weekly growth, feed efficiency and blood biochemical changes, with treatments terminated at 6weeks age. Result: There was significant depression in live weights for both dietary-toxin groups from 2nd week onwards till completion. Mortality (0-6 weeks) was 85% in T2, while T1 was in between control and T2, both for mortality (45%) and morbidity. Feed-consumption and conversion for either toxin groups remained significantly (p≤0.05) poor, with T2 resulting in erratic FCRs, ranging from 1.23 to 4.95, across weeks. A typical AFB1-induced lameness in ducklings beyond 3 weeks of AFB1-exposure, emerged as a hallmarked morbidity, in varied proportions, in T1 and T2, but not in control. The study confirms that acute-depression of juvenile growth and high-morbidity are distinct outcomes from AFB1’s presence in Pekin diets @ 200 ppb level or higher, with such leg deformities emerging as hallmarked features of Pekins reared on AFB1-spiked diets. It can be concluded that, while the AFB1 content of juvenile White Pekin ducks should be kept limited to the recommended safe levels ( less than 10 ppb); exceeding a threshold of 200 ppb is sure to cause poor growth and FCR, with adverse blood biochemical changes, high mortality, morbidity and lameness.

ACL reconstruction, medial meniscus repair and high tibial osteotomy done as a single stage procedure in a case of neglected ACL and partial medial meniscus tear with a subsequent varus knee: A case report

A long standing anterior cruciate ligament (ACL) tear causes progressive degenerative changes in the knee. This leads to secondary meniscal lesions, cartilage degenerative changes and subsequent varus angulation.A 27 year old male footballer presented to us with a traumatic right knee pain and swelling with recurrent instability, since 8 years. On examination there was knee laxity with an obvious varus deformity of the right leg. Radiographs showed medical compartment osteoarthritis and MRI was suggestive of a chronic ACL and medial meniscus tear. A single step salvage procedure of ACL reconstruction, medial meniscus repair and valgus producing high tibial osteotomy (HTO) was done for this patient. Post operatively there was no knee laxity and instability. At one year follow up, the patient had a satisfactory outcome with a painless and complete knee range of motion and had full weight bearing.In this case report we have shown how a single step salvage procedures with biological reconstructions can be done for patients with chronic ACL and medial meniscus tear patients with varus angulation, with a good outcome. Hence, simultaneous reconstructions of the ACL and medial meniscus with HTO can be used as a novel management technique to delay arthroplasty in young patients with unstable arthritic knees.

PHYSIOTHERAPY REHABILITATION IN PATIENT WITH BOW LEG DEFORMITY

The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that run alongside the tibia and the knee cap are the other bones that makes the knee joint. Osteoarthritis is the most common form of arthritis and often affects the knee, due to ageing. It can be common in children also. Prompt physical therapy leads to achieve functional goals. Bow leg deformity also called as genu varum. In this the legs are curved outwards at the knees. It is rarely serious and usually goes away with treatment. A 58-year-oldlady presented with genu varum which was diagnosed since last six years. The patient complains of chronic pain and was unable to walk and sit on the floor. The patient started physiotherapy treatment which comprise of exercises, electrotherapy, gait training for a period of six weeks which resulted in improvements in pain, range of motion, functional activities. The present case report suggests that classic and prompt structure physical rehabilitation led to improving the functional goals progressively and significantly which majorly leads to a successful recovery

Conservative treatment of the longitudinal flatfeet in children

Introduction. A significant percentage of the musculoskeletal system pathology in children is currently fall on the foot pathology – longitudinal flatfeet, which is not only a medical, but also a social problem. The incidence of this pathology is up to 58% of the total orthopedic foot pathology.
 Traditional methods of treatment and prevention of mild (I– II severity) longitudinal flatfeet (LF), which are known today (massage, physiotherapy exercises, the use of orthopedic devices, electromyostimulation) do not give a significant effect and a stable, long-term result. This makes us look for more effective methods of conservative treatment of LF of the I– II severity degree, which have a pathogenic orientation and physiological effect.
 Purpose of the work: to develop the most effective algorithm for the complex conservative treatment of LF, depending on the severity, hemodynamic disorders, deformity options, foot rigidity.
 Materials and methods. Conservative treatment was carried out in 62 patients aged 10– 18 years with LF of the I– II severity degree. Depending on the clinical manifestations and examination results, the treatment was carried out in two stages. At the first stage, serial casting was used (in the presence of concomitant deformations – silicone pelottes were used).
 Results. The results of the two-stage conservative treatment of LF demonstrate the effectiveness of serial casting in combination with the use of silicone pelottes and biostimulators in comparison with traditional methods of foot correction.
 Conclusions. Algorithms for conservative treatment of LF were developed, depending on the severity, nature of the deformity, hemodynamic disorders and muscle tone of the lower leg and foot.

RAB33B and PCNT variants in two Pakistani families with skeletal dysplasia and short stature

BackgroundSkeletal dysplasia is a heterogeneous group of disorders resulting from different genetic variants in humans. The current study was designed to identify the genetic causes of skeletal dysplasia and short stature in two consanguineous families from Pakistan, both comprised of multiple affected individuals. Patients in one family had proportionate short stature with reduced head circumference while affected individuals in the other family had disproportionate short stature.MethodsClinical data were obtained and radiological examinations of the index patients were completed. Whole genome sequencing for probands from both families were performed followed by Sanger sequencing to confirm segregation of identified variants in the respective families. In-silico pathogenicity score prediction for identified variant and amino acid conservation analysis was completed.ResultsWhole Genome Sequencing identified a known biallelic variant c.6176_6189delGTCAGCTGCCGAAG; p.(Gln2060ArgfsTer48) in PCNT gene and a novel biallelic variant c.174delC; p.(Asp60ThrfsTer7) in RAB33B gene respectively in affected members of the two families. Clinical imaging revealed platyspondyly and varus deformity in the legs of the affected members in the first family. Radiographs indicated severe platyspondyly, genu valgus deformity of legs and pectus carinatum for the patients in the second family.ConclusionIn this study we report the phenotypes and genetic variants in two unrelated families with two distinct forms of skeletal dysplasia. This study strengthens the previous findings that patients harboring PCNT variants are phenotypically homogeneous and also extends the genotypic spectrum of RAB33B variants.

TIBIAL PHYSEAL RESPECTING TUNNEL DRILLING TECHNIQUE FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN SKELETALLY IMMATURE ATHLETES

Background:ACL reconstruction is common in young patients.Hypothesis/Purpose:To report outcomes of a novel tibial drilling technique using an inside-out socket drilling method, with a drill pin and epiphyseal socket drilling in skeletally immature patients. Minimizing disruption to the tibial physis, attempting to prevent growth disturbance with an anatomic ACL that eliminates the graft bend angle at the tibial tunnel.Methods:We used a standard all-epiphyseal drilling technique for femoral preparation. The tibial drill guide, set at 55° for our tibial physeal respecting approach, is positioned in the posterior third of the ACL footprint in-line with the posterior aspect of the lateral meniscus anterior root. The FlipCutter (Arthrex Inc., Naples, FL) is drilled from the external proximal tibia. Thus, only a 3.5mm diameter tunnel crosses the proximal tibial physis. With the FlipCutter deployed, the cutting radius is checked to confirm proper position without risk of damage to the meniscal root, PCL, or articular cartilage. With fluoroscopic guidance, the tibial socket is drilled from the intra-articular surface towards the physis, stopping proximal to the physis. This results in a 15 to 20 mm all-epiphyseal socket length. We collected demographics, re-tear rate, physeal arrest (partial/complete), and patient reported outcomes in order to understand potential problems and mid-term outcomes of this procedure.Results:Eight male patients were included in the study (average age=10.6±1.5 years). All patients had radiographs >6months post-surgery, and no patient had a clinically significant leg length discrepancy (>2cm) or deformity. The two patients followed >24months post-operatively were cleared to return to sports by one year. No patients demonstrated a positive Lachman or pivot shift test at >6months follow-up. No Patients had a ROM deficit at >6months follow-up. Five patients completed Pedi-IKDC and Lysholm assessments (time from surgery=16.2months+10.6months; range 7–28.8months). Average IKDC and Lysholm scores were 88+10 and 95+9, respectively. There were no graft ruptures in the cohort (average follow-up: 13.8months±8.9 months; range 6.8–30.6months).Conclusion:Our preliminary data from this novel tibial physeal respecting technique suggest it may be appropriate for skeletally immature patients with sufficiently large enough femoral epiphyses to hold a 10mm graft tunnel without disturbance to the physis. This technique seems successful in terms of graft survival, patient reported outcomes, and no growth disturbance within 2 years of surgery, although we recognize our small sample size as a limitation. Further studies will better evaluate long-term outcomes of this pediatric ACLR technique.

Iliopsoas Abscess in Children – A Forgotten Diagnosis

Iliopsoas abscess is a rare diagnosis in children. We recently encountered two cases which were managed at our institution. A 11-year female presented with thigh and inguinal swelling while 3-year male child presented with limp and fixed flexion deformity of right leg. Due to the differing presentation, imaging studies are often important before management is planned. Ultrasound scan is the most common investigation followed by computerized tomography (CT) scan in a selected few. The girl underwent a CT scan followed by incision and drainage (I&D) of the iliopsoas abscess while the boy underwent ultrasound-guided pigtail catheter insertion. Both cases were successfully treated. Atypical presentation of iliopsoas abscess makes the diagnosis difficult and requires a high degree of clinical suspicion for making correct diagnosis. Imaging studies help with diagnosis in such cases. Less invasive techniques like image-guided aspiration and catheter drainage can be helpful in carefully selected cases. Keywords: Iliopsoas abscess, Atypical presentation, Percutaneous drainage, Pediatric.

Management of Mild Lower Extremity Deformity and Leg Length Discrepancy

Limb malalignment and length discrepancy are common problems treated by pediatric orthopaedic surgeons. These deformities may increase the rate of degenerative disease of the knee, hip, and spine. Previous teaching suggested that there were no long term consequences of mild deformity, however, newer studies suggest that there may be morbidity associated with as little at 5 mm of leg length discrepancy. There are many etiologies that can contribute to limb deformity, and so a thorough history and physical is key to management. Pediatric patients present the unique opportunity to utilize the growth of the physis to correct these deformities with adequate planning. Alternatively, lengthening techniques have become safer and are associated with excellent patient satisfaction. The mounting evidence of the long term consequences of leg deformity, coupled with more sophisticated correction techniques, brings traditional indications for deformity correction into question.

Distance from the magnification device contributes to differences in lower leg length measured in patients with TSF correction

IntroductionIn absence of deformity or injury of the contralateral leg, the contralateral leg length is used to plan limb lengthening. Length variability on long-leg weight-bearing radiographs (LLR) can lead to inaccurate deformity correction. The aim of the study was to (1) examine the variability of the measured limb length on LLR and (2) to examine the influence of the position of the magnification device.Materials and methodsThe limb lengths of 38 patients during deformity correction with a taylor-spatial-frame were measured retrospectively on 7.3 ± 2.6 (4–13) LLR per patient. The measured length of the untreated limb between LLR were used to determine length variability between LLR in each patient. To answer the secondary aim, we took LLR from a 90 cm validation distance. A magnification device was placed in different positions: at the middle of the 90 cm distance (z-position), 5 cm anterior and 5 cm posterior from the z-position, at the bottom and top of the validation distance as well as 5 cm medial and 15 cm lateral from the z-position.ResultsThe measured length variability ranged within a patient from 10 to 50 mm. 76% of patients had a measured limb length difference of ≥ 2 cm between taken LLR. Compared to length measurement of the 90 cm test object with the magnification device in the z-position (90.1 cm), positioning the device 5 cm anterior led to smaller (88.6 cm) and 5 cm posterior led to larger measurements (91.7 cm). The measured length with the magnification device at the bottom, top, medial or lateral (90.4; 89.9; 90.2; 89.8 cm) to the object differed not relevantly.ConclusionsHigh variability of limb length between different LLR within one patient was observed. This can result from different positions of the magnification device in the sagittal plane. These small changes in positioning the device should be avoided to achieve accurate deformity correction and bone lengthening. This should be considered for all length and size measurements on radiographs.

Radiographic Evaluation of Iatrogenic Errors of Root Canal Treatments Performed in an Undergraduate Dental Clinic

Introduction: Iatrogenic errors may occur during root canal treatments (RCTs) performed by undergraduate students. The current study explores the iatrogenic errors of RCTs made by undergraduate students at Gorgan School of Dentistry, Golestan, Iran. Methods: This cross-sectional study was conducted using 236 randomly selected treatment records of RCTs performed on first molars by undergraduate dental students. Periapical radiographs were independently explored for the following errors: overfilling, underfilling, legde formation, and apical transportation. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 17.0, and a Chi-square test at the 0.05 level of significance. Results: Periapical radiographs of 236 endodontically treated first molars were assessed. The results showed that 87.1% of root canals were adequately filled to the working length. Among the teeth treated by fifth- and sixth-year students, 62.5% and 66.4% of teeth were adequately filled to the working length, respectively, resulting in no statistically significant difference (P>0.05). In respect to the prevalence of ledge formation and apical transportation errors, there was no statistical difference either between the treatments performed by fifth- and sixth-year students (P>0.05) or the location of the treated tooth (mandible or maxilla) (P>0.05). Conclusion: Within the limitations of the present study, the results showed a rather low, but non-negligible prevalence of procedural errors in RCTs performed by fifth- and six-year undergraduate students at Gorgan School of Dentistry. Prevalence of errors made by fifth- and six-year students was similar.

Leg lengthening and deformity correction in rare bone diseases: amultidisciplinary approach.

Congenital and acquired conditions presenting with leg length discrepancy, leg deformity or short stature are not only achallenge for paediatric orthopaedic surgeons in terms of treatment options but may also involve anumber of medical specialties due to the complex clinical manifestations of the diseases. Various surgical treatment options are available for these rare genetic diseases, including bone lengthening and growth inhibition techniques for lower limb discrepancy, as well as guided growth and other surgical procedures for correction of angular deformities. Surgical techniques may be similar, but the treatment plans and specific multidisciplinary approaches may differ. The present report is focused on paediatric orthopaedic and multidisciplinary aspects of the treatment of rare bone diseases. We address the clinical presentation of these diseases, gait and surgical procedures for conditions such as achondroplasia, X‑linked hypophosphatemia and osteogenesis imperfecta. We also provide ashort overview of other rare bone diseases.

Niacin requirement of broilers fed maize - palm kernel meal based diets

A total of 350 day-old commercial broiler chicks were used in a trial aimed at estimating niacin requirement of broilers fed practical ration based on maize - palm kernel meal. The test diet was supplemented with varying levels of racin so that the rations had 15.0, 22.5, 30.0, 37.5, 45.0, 52.5 and 60.0 mg of the vitamin per kg of feed and were fed to 7 duplicate floor pens with 25 chicks each. The treatments were maintained for a period of 42 days. Estimation of live weight gain, feed intake, apparent utilisation of nitrogen, metabolizable energy, calcium and phosphorus and carcass characteristics, and the incidence of dermatitis and leg deformities showed that dietary niacin level of 37.5 mg/kg feed was adequate for achieving good nutrient utilisation, optimising productive performance and for maintaining good health.

Deformity progression in congenital posteromedial bowing of the tibia: a report of 44 cases

Backgroundcongenital posteromedial bowing of tibia (CPMBT) is a very rare birth defect, characterized by shortened bowed leg and ankle deformity. We described a single institution experience in the management of CPMBT.Methodswe identified 44 CPMBT in 44 children. The age at presentation was 5.5 ± 5.6 years and the mean age at the final review was 10.1 ± 4.8 years. Radiographic evaluation included the antero-posterior and lateral inter-physeal angle (AP-IPA and L-IPA), the limb length discrepancy (LLD), the morphology of the distal tibia and the lateral distal tibial angle (LDTA). During the study period, 26 children underwent surgical treatment.Resultsthe estimated curves showed a progressive spontaneous correction of both AP-IPA and L-IPA during growth, but a progressive increase of the LLD. The L-IPA showed a more predictable behaviour while the AP-IPA showed a scattered correction, with a wider variation of the estimated final angle. The final LDTA was 85.3° ± 4.2° and was correlated with the L-IPA (r = 0.5; p = 0.02).Among the 26 children who underwent surgical treatment, 23 cases had limb lengthening, 1 case had contralateral epiphysiodesis, 1 child underwent tibial osteotomy, 1 patient was treated by hemiepiphysiodesis of the distal tibia to correct ankle valgus deformity.Conclusionsour study described the largest case series of CPMBT. A combination of surgical treatments, in a staged surgical process, should be tailored to the developmental characteristics of this abnormality. An experience-based algorithm of treatment is also proposed. Further studies are needed to understand which is the best strategy to correct this deformity during childhood.Level of evidencelevel IV prognostic study.

Plastic surgery of extensive soft tissue defects of the lower leg in children with the use of a parotid flap after its prefabrication with tissue expanders (preliminary report)

Background. Extensive deep soft tissue defects in children are an indication for the microsurgical reconstruction using autotransplantation of a tissue complex. The use of a flap prefabrication before their microsurgical transplantation to various segments and areas is a promising approach in reconstructive surgery.
 Aim. The aim of this study was to evaluate the possibilities and immediate results of plastic surgery of extensive soft tissue defects of the lower leg with a tissue complex, after its prefabrication with a tissue expander, and the state of the donor area in different surgical treatment options.
 Materials and methods. Six patients aged 13 2.3 years were operated on for deep scar deformities of the lower leg and foot. For plastic surgery, a pericarpial flap was used. In two patients, the flap was prefabricated with tissue expanders at a volume of 720 ml. After filling the expander, the second stage of surgical treatment was performed. First, the expander was removed. Next, the flap on the artery surrounding the scapula was isolated. Last, it was transplanted into a soft tissue defect of the lower leg with the imposition of microvascular anastomoses. A layer-by-layer suture was applied to the donor wound. The Vancouver scale was used to assess the quality of the scar tissue in the donor area.
 Results. The removal of the tissue complex after the prefabrication with expanders made it possible to perform plastic surgery of extensive soft tissue defects of the lower leg in one stage of surgical treatment with the application of a cosmetic suture in the donor area. There were no complications in the postoperative period.
 At the examination after six months, patients who did not undergo flap prefabrication complained of cosmetic defects and discomfort when moving in the donor area.
 The evaluation of the quality of scar tissue by the Vancouver scale showed that the scars in patients after flap prefabrication were similar to optimal (total score in two patients is 2). In two patients without flap prefabrication, the total score was 7, and in two patients, it was 9, which indicated unsatisfactory cosmetic parameters of the postoperative scar.
 Conclusion. The prefabrication of a tissue complex using tissue expanders before microsurgical transplantation enables the collection of a large volume of tissue for plastic surgery of extensive defects. It also reduces the risk of trophic complications in the postoperative period and creates optimal conditions for closing the donor site.

Changes in the representation of body deformities of primary school students under the influence of a six-month program

Proper body posture should be at the very top, as this is the basic prerequisite of good health, normal growth, and development. The aim of this research was to determine significant differences between the initial and final measurements in the results of body deformities in students of classroom teaching. The study was conducted on a sample of 1105 students, aged 5 – 12 years. Diagnosis of body posture was performed according to Napoleon Wolanski's criteria. Measuring instruments/tests were used to measure the curvature of the spine, and the check of the structure of the feet was performed by the method of plantography. By analyzing the posture variables of individual body parts of the sample studied, using descriptive statistics, it was determined that there was a statistically significant representation of physical deformities, as well as statistically significant differences between the initial and final measurements in the results of physical deformities of class teaching students. The analysis of the obtained results provided data showing that in the initial measurement 231 students of class teaching have chest deformities, 792 students have spinal deformities, 267 students have leg deformities and 671 students have foot deformities. In the final measurement, 123 class teaching students have chest deformities, 488 students have spinal deformities, 133 students have leg deformities and 439 students have foot deformities. Based on the research it can be concluded that the frequency of physical deformities can be significantly reduced by planned and continuous corrective procedures, i.e. by applying appropriate content in physical and health education classes.

Farmers' Perceptions About Health and Welfare Issues in Turkey Production.

Farmers play an essential role in the management of animals and ensuring their health and welfare. However, relatively little is known about the health and welfare-related issues farmers themselves find important in the turkey sector. As part of a larger study, a cross-sectional survey of turkey farmers was conducted in Canada to identify the main perceived reasons for culling, mortality, and carcass condemnations in their flocks. Additionally, farmers were asked to rate the importance of different health and welfare-related issues (i.e., mortality, aggressive pecking, disease, leg injuries, leg deformities, breast injuries, and varying body size) during their summer and winter production, as well as for the sector as a whole. A total of 83 responses were analyzed (response rate 20%). The most frequently mentioned reasons for the culling of turkeys included leg-related issues (90.0%), sickness (60.5%), and small body size (58.0%). The perceived reasons for mortality were most often unknown (59.7%), or related to cannibalism (41.6%) or dehydration (42.9%). The main reasons for carcass condemnations at processing were related to skin (33.8%) or subcutaneous conditions (64.7%). Leg deformities and mortality were considered the biggest issues for the turkey production sector. In general, farmers rated items as more of an issue when the question pertained to the sector as a whole rather than to their farm. These results increase our understanding of the health and welfare-related problems in turkey production that farmers find important. This can ultimately help focus research efforts in addressing these issues through improved management adaptations or breeding approaches, thereby improving both the well-being of farmers and birds.

Nationwide Turkish Cohort Study of Hypophosphatemic Rickets

Objective:Hypophosphatemic rickets (HR) is a rare renal phosphate-wasting disorder, which is usually X-linked and is commonly caused by PHEX mutations. The treatment and follow-up of HR is challenging due to imperfect treatment options.Methods:Here we present nationwide initial and follow-up data on HR.Results:From 24 centers, 166 patients were included in the study. Genetic analysis (n=75) showed PHEX mutation in 80% of patients. The mean follow-up period was 6.7±2.4 years. During the first 3-years of treatment (n=91), mild increase in phosphate, decrease in alkaline phosphatase and elevation in parathyroid hormone (PTH) levels were detected. The height standard deviation scores were -2.38, -2.77, -2.72, -2.47 at initial, 1st, 2nd and 3rd year of treatment, respectively (p>0.05). On follow-up 36% of the patients showed complete or significant improvement in leg deformities and these patients had similar phosphate levels at presentation with better levels in 1st and 2nd years of treatment; even the treatment doses of phosphate were similar. Furthermore, 27 patients developed nephrocalcinosis (NC), the patients showed no difference in biochemical differences at presentation and follow-up, but 3rd year PTH was higher. However, higher treatment doses of phosphate and calcitriol were found in the NC group.Conclusion:HR treatment and follow-up is challenging and our results showed higher treatment doses were associated with NC without any change in serum phosphate levels, suggesting that giving higher doses led to increased phosphaturia, probably through stimulation of fibroblast growth factor 23. However, higher calcitriol doses could improve bone deformities. Safer and more efficacious therapies are needed.

Surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia\u2014a retrospective comparative analysis

IntroductionThis study compared surgical treatment outcomes of the Ilizarov and internal osteosynthesis methods in posttraumatic pseudarthrosis of the tibia.Material and methodsIn a retrospective comparative study, 75 patients were treated with the Ilizarov technique for aseptic posttraumatic pseudarthrosis of the tibia in the period 2000–2016. We compared them with the 51 patients from the control group, treated for tibial bone union disturbances using internal osteosynthesis methods, i.e., internal-fixation plates and intramedullary nails. The study groups were compared in terms of the rates of union, time to union, and the baseline-to-postoperative difference in lower leg deformity.ResultsUnion rate in the Ilizarov group was 100% and the control group was 51.92% (p < 0.001). The median time to union suggests that patients from the Ilizarov group needed a shorter time to achieve bone union (203.00 days vs. 271.00 days) (p = 0.091). The effect size in the Ilizarov group was larger both in terms of reducing both limb deformity and shortening (it is worth noting, however, that the Ilizarov treatment was used in patients with higher baseline values of both these parameters). We observed no significant difference in terms of time to union between the group of patients with at least one risk factor for disturbance in fracture healing and the group with no risk factors. The following risk factors were considered: diabetes mellitus, corticosteroid therapy, smoking, alcohol dependence, and advanced lower-extremity vascular disease (p = 0.827).DiscussionOur study demonstrated a high effectiveness of the Ilizarov method in the treatment of aseptic posttraumatic pseudarthroses of the tibia. The Ilizarov method seems to be worth considering in all cases where either the patient or the nature of injury is associated with additional risk factors and whenever there is a need for leg deformity correction or leg elongation.

Quantitative study on SLIP model parameters based on multi-rigid-body dynamics

The spring-loaded inverted pendulum (SLIP) model is often used to describe the interaction between hindlimbs and the ground during the locomotion of animals or humans. This model is frequently adopted to qualitatively explain the flexible deformation of legs and feet and the trajectory change of center of mass (COM), caused by the impact between hindlimbs and the ground. However, such research cannot provide precise reference on the structural parameters, spring and damper selections and their collocations for the design of robotic legs and feet. In this study, an SLIP model was established on the multi-rigid-body dynamics software Adams. The main influence factors on the SLIP model were determined by targeting at the touchdown-phase duration of animal or human locomotion. Then the main factors were quantitatively studied by combining a multivariate orthogonal polynomial regression design. Simulation showed that spring stiffness coefficient (Z1), damping coefficient (Z2), swing angular velocity (Z3) and initial swing position (Z4) were the main factors affecting the trajectory of COM. Multivariate orthogonal polynomial regression analyses showed the relationship between the COM fluctuation (y) and the main factors satisfied the following equation: y = 217.33 - 16.25 Z1 + 0.3975 Z12 - 194.6 Z2 - 0.953 Z3 + 0.755 Z4 + 8.1 Z1 Z2 + 0.043 Z1 Z3 + 0.6 Z2 Z3 - 0.0055 Z3 Z4.

Osteoporosis pseudoglioma syndrome

ABSTRACTOsteoporosis pseudoglioma syndrome is characterized by intellectual disability, osteoporosis of bones and eye abnormalities. We report, a 14-year-old female child presented with walking difficulty with frequent falls followed by deformity of left leg. On examination, bilateral micropthalmia, microcornea, corneal clouding, vitreo-retinal detachment, and atrophic irises. She had deformity of left lower limb, anterior bowing of both tibia, lax skin, hyperextensible joints. Skeletal survey showed severe osteoporosis with fracture of left femur and fish mouth vertebra. She had normal serum calcium, phosphorus, and alkaline phosphatase levels. Targeted next generation testing revealed homozygous pathogenic variant in exon 6 at c.1096G>A/p.V366 M and confirmed by Sanger sequencing. Early diagnosis and treatment are helpful in preventing further fractures and osteoporosis.