Minimal Radiographic Changes Research Articles

Minimally invasive procedures in the early stages of trapeziometacarpal joint osteoarthritis : Denervation, arthroscopy and autologous fat transplantation

Resection arthroplasty of the trapezium with or without tendon interposition is the standard procedure in the treatment of advanced, symptomatic thumb carpometacarpal joint osteoarthritis. Treatment recommendation in the early stages without visible or minimal radiographic changes is often difficult, especially when conservative treatment methods have already been exhausted. In these cases, there is the possibility of the minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation. Which minimally invasive procedures are available for the treatment of thumb carpometacarpal joint osteoarthritis and how is their value to be assessed? The minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation for the treatment of thumb carpometacarpal joint osteoarthritis are described and current results from the literature are discussed. Good results have been reported with all three procedures. However, the reports are almost exclusively based on retrospective studies with small numbers of patients, which lack control groups, so the results cannot be regarded as definitive. Denervation, arthroscopic procedures and autologous fat transplantation appear to be suitable methods in the early stages of thumb carpometacarpal joint osteoarthritis. Further studies, especially comparative randomised trials that report medium and long-term results, would allow further assessment of these methods.

The Evolution and Role of the Bursal Acromial Reconstruction

Background: Massive, irreparable rotator cuff tears (RCTs) remain a challenging clinical problem with numerous described treatment options. Bursal acromial reconstruction (BAR) represents a promising and evolving technique for a subset of patients with irreparable RCTs. Indications: BAR is indicated for patients with massive, irreparable RCTs with a primary complaint of pain, well-compensated shoulder function, and minimal radiographic degenerative changes of the glenohumeral joint as an alternative to reverse total shoulder arthroplasty or superior capsular reconstruction. Technique Description: Positioning per surgeon preference and diagnostic arthroscopy is performed. Subacromial decompression with a minimal and gentle acromioplasty is performed, followed by assessment of RCT repairability. If the tear is deemed irreparable, acromial measurements in the medial-lateral and anterior-posterior dimensions are obtained. Two pieces of acellular dermal allograft are cut to the acromial dimensions and affixed together using fibrin glue. The reactive side (facing the acromion), medial, and anterior sides of the graft are labeled. Two suture tapes are passed through the corners of the graft and self-locked and run diagonally in a cruciate configuration using an antegrade suture passer. Medial and lateral #2 fiberwire sutures are placed in a luggage-tag configuration. Neviaser (posterior), middle, and anterior acromioclavicular joint portals are created for medial sided suture passage. Medial graft sutures are shuttled through the respective medial portals and the graft is pulled into the subacromial space. The lateral sutures are then removed from percutaneous posterolateral, middle lateral, and anterolateral portals along the acromial edge. Medial sutures are retrieved using a suture grasper subcutaneously on top of the acromion through the percutaneous lateral portals. The sutures are tied through the lateral portals, starting with the medial-lateral sutures, and the knots are buried. Postoperatively, patients are progressed through passive, active-assisted, and active range of motion between weeks 2 and 6 and strengthening is progressed at 6 weeks. Results: Clinical results are lacking in the literature, but anecdotal results in our institution have demonstrated promising early outcomes. Discussion/Conclusion: BAR represents a promising alternative in the array of surgical options for treatment of irreparable RCTs.

Chronic Back Pain Suspected Sacroiliitis, Seronegative-Spondyloarthropathy related Sacroiliitis: Features and Differentials

Introduction: Very often late diagnosis in spondylitis ankylosans (SA) in the period between 5 to 10 years is due to unstandardized diagnostic method besides established diagnostic criteria. But they are very restrictive and not practical for early diagnosis of SA, because are based on proved radiographic changes. Aim: Sacroiliitis (SI) as a sole entity rarely exists, usually is a part of a diagnostic mosaic of SA and related spondyloarthropathies (SpA). Surely proved SI clinically and radiographically means sure diagnosis of SA, especially in the early stage of the disease. Material and Methods: Highly selective group of patients with SA was followed in the period of one year: group of 23 patients (pts) with unconvincing radiographic changes for SA from 1-2° and group of 21 pts without radiographic changes i.e. 0°. Beside SA, both groups fulfilled at least another from the listed conditions: 1. Oligoarthritis; 2. Enthesitis; 3. Iridocyclitis; 4. Positive family history for SA; 5. Positive antigen HLA-B27 and 6. Elevated ESR > 30mm/h. Results: after observational period of one year in the group A 11/21 pts were with SA. In the group B only 6/23 pts were with SA; the others were transformed in different directions: 4/23 in the group of spondyloarthropathies (SpA) – 2 pts with Psoriatic spondyloarthropathy (PsSpA), 1 patient with Reiter syndrome (RS)and 1 patient with Entericspondyloarthropathy (ESpA). The others 8/22 pts were still undefined SpA. Conclusion: Our results showed that defining of SA was crucial in the diagnosis of SA. The fact that most of cases with authentic SA were in group A with minimal radiographic changes from 1-2° in comparison with group B without radiographic changes showed the necessity of using other imaging techniques (scan, MRI) for earlier detection of SI in the so called pre-radiographic stage which lasts 2-4 years, when radiographic findings are absent. Clinical (symptomatic) SI without radiographic changes according to the findings of pts in the group B gives a possibility for overlap to other entities in the group of SpA.

Flexor Enthesopathy of the Elbow in Three Dogs: Imaging and Surgery

The aim of the study was to describe the radiographic and computed tomography (CT), findings in three dogs with elbow flexor enthesopathy. The study was a clinical one with client-owned dogs. In two dogs, lameness was localized to the elbow by clinical examination. Radiographic examination and CT were performed, and flexor enthesopaty was observed also in the third dog as an incidental finding. Flexorenthesopathy was diagnosed in all three dogs (4 joints) by combining the minimal radiographic changes with specific CT findings. Conservative and surgical treatment were performed. In all joints, any other pathology were excluded. In all three dogs, the elbow condition improved on long-term. Flexor enthesopathy at the medial epicondyle is an unrecognized condition and is a possible cause of elbow lameness in the dog.

Medication related osteonecrosis of the jaw in osteoporotic vs oncologic patients-quantifying radiographic appearance and relationship to clinical findings.

To explore whether differences exist in the clinical and radiographic presentation of oncologic vs osteoporotic patients with medication-relatedosteonecrosis of the jaw (MRONJ). We retrospectively assessed panoramic radiographs and CBCT examinations of 70 MRONJ patients receiving antiresorptive medications for the management of either osteoporosis or bone malignancy. Radiographic features of MRONJ were documented and categorized according to severity. A composite radiographic index (CRI) was constructed to account for the heterogeneity in radiographic manifestations of MRONJ and further stratify extent of osseous changes. Patients with osteoporosis were mostly older females and presented more frequently with Stage 2 MRONJ, while patients with malignancy were equally distributed between males and females, and presented mostly with Stage 1 MRONJ. Most MRONJ lesions in oncologic patients occurred in the mandible, whereas the maxilla and mandible were equally affected in osteoporotic patients. Patients with minimal radiographic changes (low CRI score) often presented with MRONJ in dentate areas, while most patients in medium and high CRI groups presented with MRONJ after recent tooth extraction. The low CRI group consisted of primarily oncologic patients, while osteoporotic vs oncologic patients were divided more evenly in the other CRI groups (p = 0.083). While CRI scores increased with clinical staging, a Spearman's rank correlation coefficient of 0.49 suggests that clinical appearance does not reliably predict osseous changes. Our data identify differences in the MRONJ appearance of patients with osteoporosis vs malignancy and emphasize the significance of detailed radiographic assessment, in addition to the clinical appearance, in characterizing the osseous changes of the disease.

Clinical and radiographic outcomes after total shoulder arthroplasty with an anatomic press-fit short stem

There is limited information assessing outcomes after total shoulder arthroplasty (TSA) with a press-fit short stem. The purpose of this study was to evaluate early clinical and radiographic outcomes and complications after TSA with an anatomic press-fit short stem. We identified 118 TSAs completed with press-fit short stem and minimum 2-year follow-up; 85 of these patients had a grit-blasted (GB) short stem placed, whereas 33 patients had short stems with proximal porous coating (PPC). Shoulder function scores, active mobility measurements, and radiographs were assessed. The average age at surgery was 66.7 years, with average follow-up of 3 years. Significant improvements were noted for all shoulder function scores and active mobility measurements from the preoperative state to final follow-up (P < .001). There was no stem loosening in any patients with minimum 2-year follow-up; however, 3 female patients with GB stems had gross loosening of their humeral components before 1 year, 2 requiring revision. Radiolucent lines around the humeral component were found in 5.9% without evidence of loosening. Osseous resorption at the medial cortex was noted in 9.3%. Of patients with PPC stems, no patients were observed to have radiolucent lines compared with 8.2% in the GB group (P = .09). TSAs with anatomic press-fit short stem showed significant clinical improvements from the preoperative state to final short-term follow-up, with few complications and minimal radiographic changes. Lack of PPC may contribute to early loosening in patients with poor bone quality. The authors now use a short stem with PPC.

A Novel Equine Hoof Lamellar Tissue Biopsy Technique

This study aims to validate the efficacy of a new device specifically developed for equine lamellar biopsy. Nine adult horses were used. Under sedation and digital nerve perineural anesthesia and after keratinized tissue thinning, a sample from the dorsal lamellar stratum was obtained using an instrument called Falcão-Faleiros' lamellotome. Hoof pain sensitivity was evaluated for 60 days, and horses were monitored for 6 months. Lateromedial radiographic images to analyze the spatial relationship between the distal phalanx and the hoof capsule were obtained before and 30 days after the biopsy. The effect of time on the variables was statistically analyzed (P < .05). On average (±SD), the biopsies produced samples that were 2.32 (±0.64) cm in length, 0.48 (±0.09) in width, and 0.51 (±0.11) cm in depth. A mean of 69 of intact primary epidermal lamellae was obtained per biopsy sample. Lameness and sensitivity to hoof testers were evident during the first 4 days postbiopsy but returned to basal levels after the fifth day. Minimal radiographic changes were observed, and the horses completely returned to their regular activities after 60 days. All biopsied hoofs grew normally during the 6-month period, making the dorsal wall defects reach the ground level. The use of the lamellotome for equine hoof lamellar biopsy produced an adequate quality and quantity of tissue for histology and allowed for full clinical recovery of the horses.

Roach’s Type Ii Variant of Sturge - Weber Syndrome : A Case Report

Sturge- weber syndrome is a neurocutaneous disorder caused by persistence of transitory primordial arteriovenous connection of the foetal intracranial vasculature. It manifests with vascular malformations involving the brain, eye and skin with resulting neurological and orbital manifestations. Port wine stain, glaucoma and seizures are some of the commonly seen symptoms, depending on the presence of these features sturge weber syndrome has been classified by Roach into three types. We report a case of a 26 year old female with facial portwine stain and minimal neurologic manifestations, which according to Roach’s classification falls in type II category. This report also underlines the need for detailed laboratory and neurologic work up of all patients with facial portwine stain present along the distribution of trigeminal nerve, as the neurologic manifestations in sturge–weber syndrome may vary in severity from seizures and mental retardation to minimal radiographic changes. It also emphasizes the need for identification of such rare variants of this syndrome.

Arthroscopic Synovectomy of the Ankle in Rheumatoid Arthritis

To evaluate the outcome of arthroscopic synovectomy of the ankle joint in patients with early-stage rheumatoid arthritis (RA). Between 2005 and 2009, 18 consecutive patients with RA involving the ankle underwent arthroscopic synovectomy. Pain was measured using a visual analog scale (VAS), and clinical outcome was determined by calculating the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score with a mean follow-up of 5 years (60 months). Assessments were performed preoperatively, at 6 and 12 months postoperatively, and then yearly thereafter. Clinical success was defined as the absence of synovitis symptoms or when patients demonstrated good or excellent outcomes (AOFAS Ankle-Hindfoot Scale score ≥80) with >50% improvement in VAS score for pain. Demographic, laboratory, and radiological variables were evaluated to determine possible factors predicting clinical outcome. VAS and AOFAS scores were significantly improved at the final follow-up (60 months; P < .0001). The greatest improvements in clinical scores were observed after 12 months; thereafter, they steadily declined. Of the 18 patients examined, 14 (77.8%) were considered to have had clinical success with no reintervention. Variables predictive of clinical success were short duration of symptoms (P = .042) and minimal radiographic changes based on the Larsen grading system (P = .030). Arthroscopic synovectomy is a safe and successful procedure in ankle joints affected by RA. The best clinical outcomes are achieved when the procedure is performed early in the disease course and when there is no evidence of cartilage degeneration. Level IV, prognostic case series.

Primary flexor enthesopathy of the canine elbow: imaging and arthroscopic findings in eight dogs with discrete radiographic changes

To describe the radiographic, ultrasonographic, computed tomography (CT), magnetic resonance imaging (MRI), and arthroscopic findings in eight dogs with elbow lameness caused by primary flexor enthesopathy. Clinical study. Eight client-owned dogs. In all dogs, lameness was localized to the elbow by clinical examination. Radiographic examination, ultrasound, CT and MRI were performed prior to arthroscopy. In seven dogs, surgical treatment and subsequent histopathology were performed. Primary enthesopathy of the medial epicondyle was diagnosed in eight dogs (13 joints) by combining the minimal radiographic changes with specific ultrasonographic, CT, MRI and arthroscopic findings at the medial epicondyle. In all joints, any other pathology could be excluded. Histopathology of the affected tissue revealed degeneration and metaplasia in the flexor muscles. Primary flexor enthesopathy at the medial epicondyle is an unrecognized condition and is a possible cause of elbow lameness in the dog. Diagnosis is based on specific imaging and arthroscopic findings. The most important cause of elbow lameness in dogs is medial coronoid disease. Often this condition presents with minimal radiographic and arthroscopic changes. In these cases, primary enthesopathy of the medial epicondyle should be considered as a differential diagnosis, in order to make the correct treatment decision.

Acetabular Outcome after Hip Hemiarthroplasty in Patients with Tumors

Hip hemiarthroplasty is performed routinely on patients with tumors of the proximal femur, although the long-term effect on the native acetabulum is unknown. We measured the amount of femoral head migration that would occur with intermediate and long-term followup. We also measured the amount of groin pain experienced by patients with longer followup and the overall rate of conversion to total hip arthroplasty. From a surgical database, we identified 442 patients with tumors who had 447 hip hemiarthroplasties without or with an allograft composite. We reviewed the medical records and radiographs of 32 patients with at least 5 years followup (median followup, 10 years) to determine their clinical and radiographic outcomes. The median proximal and medial migration measurements were 3 mm (range, 0-24 mm) and 2 mm (range 0-20 mm), respectively. Thirty-one patients had minimal or no groin pain. Seven of the 447 arthroplasties (1.6%) were converted to total hip arthroplasties. Even patients with long-term followup usually had minimal pain and radiographic changes. The overall rate of conversion to total hip arthroplasty was low. Concern regarding excessive acetabular wear resulting in conversion to total hip arthroplasty in patients with tumors is not supported by our data.

Efficacy of zoledronate against neuroblastoma

We investigated the antitumor and antiosteoclastic effects of zoledronate against human neuroblastoma in vitro and in a murine model of bone metastasis. Antitumor activity of zoledronate against neuroblastoma cell lines was assessed by evaluating proliferation, apoptosis, and cell-cycle progression. A murine model of bone invasion was used to assess antiosteoclastic and antitumor activity in vivo. Mice were followed by radiographic and bioluminescence imaging. Treatment of human neuroblastoma cells resulted in a decrease in cell count, increase in apoptosis, and arrest of cell-cycle progression. In the model of bone invasion, mice were treated weekly with zoledronate or vehicle control 10 days after tumor cell inoculation. Five weeks later, radiographs revealed a large degree of osteolytic disease in control mice. Impressively, mice treated with zoledronate demonstrated minimal radiographic changes at this time. Bioluminescence imaging of these mice revealed a significant restriction of tumor growth during the course of therapy. Zoledronate exhibits significant antitumor activity against human neuroblastoma cells in vitro, prevents development of osteolytic lesions, and restricts tumor growth in a murine model of bone metastasis. These results suggest that clinical investigation of zoledronate or similar bisphosphonates as adjuvant therapy in neuroblastoma patients is warranted.

Radiographic findings in 20 patients with Hantavirus pulmonary syndrome correlated with clinical outcome.

Hantavirus is a rare rodent-borne pathogen responsible for the Hantavirus pulmonary syndrome. The objective of this study was to review the clinical and radiographic findings of patients presenting with Hantavirus pulmonary syndrome in northern Alberta, Canada. We retrospectively reviewed the cases of 20 patients who presented with Hantavirus pulmonary syndrome from 1989 to 1999. Two patterns of presentation were identified. One group (13/20 patients) presented with fulminant clinical and radiographic findings and required intensive care support. Six (46%) of the 13 died within a few days of presentation. Some presented in respiratory failure with bilateral parenchymal infiltrates or a rapid progression from mild bilateral interstitial changes to bilateral interstitial and alveolar infiltrates with pleural effusions. The radiographic findings paralleled these clinical symptoms. The second group (7/20) consisted of patients whose clinical course was more limited, as were their corresponding radiographic findings. These patients had a limited hospital stay, and only minimal changes were identified on radiographs. None of the second group of patients died. Clearly, in our study, the patients with Hantavirus pulmonary syndrome presented as two groups: those with the fulminant form of the illness and those with the limited type. Of the patients we studied, the group with the fulminant form presented with severe clinical symptoms and radiographic signs of pulmonary disease and had a 46% mortality rate. The group with the limited form presented with mild clinical symptoms and minimal radiographic changes and had no mortalities.

Synovial fluid cytokines and eicosanoids as markers of joint disease in horses.

To evaluate the value of various synovial fluid cytokines and eicosanoids to diagnose joint disease or categories of joint disease. Prospective acquisition of clinicopathologic data. Client-owned or donated horses: 50 joints with no evidence of disease; 28 joints with acute disease; 32 joints with chronic disease; 9 joints with cartilage damage and no other signs of joint disease. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), interleukin-6 (IL-6), prostaglandin E(2) (PGE(2)), thromboxane B(2) (TXB(2)), prostaglandin F1-alpha (PGF(1)-alpha), and leukotriene B(4) (LTB(4)), were measured in equine synovial fluid by immunoassay and categorized according to duration and degree of joint disease. Any test value for a given category that was different from normal was further analyzed for sensitivity (S), specificity (Sp), and operating point (most valid test cutoff value). Likelihood ratios and predictive values were calculated at the operating point. Mediator concentrations were correlated to synovial fluid white blood cell count. Tests were reported as poor, fair, good, or excellent based on predictive values of <.25,.25-.5,.5-.75, or >.75, respectively. TNF synovial fluid concentration as a predictor of joint disease was good, and the value of TNF (maximum S and Sp) indicating joint disease was >36 pg/mL. IL-1beta as a predictor of joint disease was good, and the value of IL-1beta indicating joint disease was >4.5 pg/mL. IL-6 concentration was an excellent predictor of joint disease. Any IL-6 in synovial fluid indicated joint disease and correlated highly with synovial fluid white blood cell count (P <.0001). PGE(2) was a good-excellent predictor of disease (positive predictive value [PPV] = 0.75), and the concentration indicating joint disease was >22.5 pg/mL. The diagnostic PGF(1)-alpha concentration indicating severe chronic joint disease was identified to be >16.5 pg/mL with very high sensitivity (S = 1) and specificity (Sp =.89). PGF(1)-alpha concentrations > 9.5 pg/mL had a good PPV (.69) and NPV (.6) for any joint disease. TBX(2) concentrations below 31.5 pg/mL (S =.57; Sp =.61) were a very good predictor of joint disease (PPV =.72). LTB(4) concentration appeared to be greater in severe acute joint disease than normal joints; this was not significant (P =.15) and correlated highly with synovial fluid white blood cell count (P =.0001). The ability of a single value from a joint in an adult horse predicting the presence of joint disease was often good (.5-.75), and was excellent (> or =.75) for IL-6 and PGE(2). TNF-alpha and IL-1beta were no more effective than white blood cell count in screening for joint disease. IL-6 was the most sensitive and specific for joint disease and could be an excellent screening test for the presence of joint disease when lameness is difficult to identify or is intermittent. PGE(2) would be a functional screening test for the presence of any joint disease and offers a differentiating feature because values were not influenced by white blood cell count. PGF(1)-alpha values > 16.5 pg/mL identified chronic severe joint disease and may be clinically useful when there are minimal radiographic changes but substantial articular cartilage degradation.

Biomechanical evaluation of the elbow following radial head fracture: Comparison of open reduction and internal fixation vs. excision, silastic replacement, and non-operative management

Thirty-six fractures of the radial head were evaluated following treatment with four different techniques: open reduction and internal fixation (ORIF), excision, silastic replacement, and non-operative management. Clinical assessment included calculation of the Clinical Performance Index based on parameters for motion, stability, pain, and daily function, as well as radiographic evaluation for fracture type (Mason) and the development of degenerative changes. Further assessment included isometric strength measurements for elbow flexion, extension, pronation, supination, and grip. Range of motion and strength measurements were similar, except for grip strength, which was significantly better for ORIF patients compared to excision or silastic replacement groups. Patients with ORIF had the best clinical scores with minimal radiographic changes. When possible, ORIF of displaced radial head fractures appears to provide the best functional result.

Can Foot Orthoses Prevent Hallux Valgus Deformity in Rheumatoid Arthritis? A Randomized Clinical Trial

Hallux valgus deformity is the most commonly observed forefoot deformity in patients with rheumatoid arthritis. This 5-year, double-blind, randomized clinical trial compared treatment orthoses with placebo orthoses for the prevention of hallux valgus deformity in the rheumatoid arthritic foot.One hundred and two subjects with active rheumatoid arthritis and with foot pain and minimal radiographic changes of the feet participated in the study. They were recruited from five arthritis clinics in the Chicago metropolitan area that are affiliated with or are teaching clinics of area medical schools. Patients were followed for 3 years.Eighty-one subjects completed the study. In a logistic regression analysis, the treatment group was 73% less likely to develop hallux valgus deformity compared with the control group (adjusted odds ratio 0.27, 95% confidence interval 0.078, 0.916 p = .04). These findings suggest that foot orthoses can prevent or slow the progression of hallux valgus deformity.

Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance).

To assess the efficacy of chest radiography in the detection of active pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS). Initial interpretations of chest radiographs of 133 adult patients with AIDS and positive sputum or bronchoalveolar lavage cultures for Mycobacterium tuberculosis were reviewed. Radiographic findings were correlated with CD4 T-cell counts, sputum stains for acid-fast bacilli (AFB), and antituberculous drug sensitivity. Forty-eight (36%) patients had a primary M tuberculosis pattern, 38 (28%) had a postprimary M tuberculosis pattern, 19 (14%) had normal radiographs, 17 (13%) had atypical infiltrates, seven (5%) had minimal radiographic changes, and four (3%) had a miliary pattern. Normal chest radiographs were seen for 10 (21%) of 48 patients with less than 200 T cells per microliter and one (5%) of 20 patients with more than 200 T cells per microliter. Drug sensitivity and sputum staining for AFB did not correlate with radiographic findings. Overall, 19% of cases had multidrug resistance to antituberculous medications. Chest radiographs did not suggest active tuberculosis in 43 (32%) of 133 AIDS patients with active pulmonary tuberculosis.

Long term follow up of haemophilic arthropathy treated by Au-198 radiation synovectomy.

Intra-articular injection of Au-198 (gold synoviorthesis) has been used in the treatment of repeated haemarthroses of the elbows, knees, or ankles in 64 haemophiliacs. These patients had continued to have joint haemorrhages despite appropriate, episodic, substitutive therapy over a period of more than six months. Follow-up for an average period of 14 years in one knee in 38 male haemophiliacs showed 8 good, 23 fair, and 7 poor results with regard to their joint scores. It is concluded that Au-198 is an effective agent for radiation synovectomy, particularly in the early stages of the disease with minimal radiographic changes. It appears to reduce the incidence of haemarthrosis and to slow the rate of evolution of radiographic changes.

Treatment of hydatid disease in childhood with mebendazole

The general characteristics of 56 childhood cases of cystic hydatid disease were analysed and the results of mebendazole therapy versus surgery were verified. Pulmonary radiograms and ultrasonography were used in the diagnosis. The cysts were localized primarily to the lungs. Twenty seven patients were surgically-treated, with eight having recurrence after a mean period of 3.6 yrs. Thirty patients received regular mebendazole treatment, in a dose of 50 mg.kg-1 with a mean duration of treatment of 11.7 months. Twenty one patients were cured and discontinued the therapy. Nine still use the drug, seven of whom have had dramatic improvement, while the other two have minimal radiographic changes but subjective improvement in general condition. The lung cysts vanished leaving minimal scars, whilst the liver cysts turned into inactive forms. The surgically-treated and drug-treated groups were similar in age, duration and severity of the disease. The recurrence rate of drug-treated children (1 out of 20) was lower than that of the surgically-treated children (8 out of 27); however, this was not statistically significant.

Subtalar Fusion for Isolated Subtalar Disorders

Retrospective observations on subtalar fusions performed for isolated subtalar disorders in 11 feet were performed to determine whether a satisfactory result could be obtained without significant changes to the talonavicular and calcaneocuboid joints. Preoperative diagnoses included five feet with degenerative arthritis secondary to a calcaneal fracture, four feet with a talocalcaneal bar, one foot with a degenerative subtalar arthropathy of unknown cause, and one foot with an unstable subtalar joint secondary to a peroneal tendon rupture. The average follow-up period was 41.5 months (range, 23-103 months). The hindfoot was fused in a average of 6 degrees of valgus. The feet maintained approximately 50% of their transverse tarsal motion, compared with the contralateral side. No foot developed hypermobility of any tarsal joint. Three feet fused for degenerative joint disease developed very mild talar beaking, and two feet fused for a tarsal coalition developed a mild progression or increase in talar beaking. Three feet demonstrated very minimal osteophyte formation at the calcaneocuboid joint. Functional and pain ratings for patients who had fusions for talocalcaneal bars or degenerative joint disease were good to excellent. Minimal radiographic changes at the talonavicular and calcaneocuboid joints secondary to increased stress brought about by the fusion did not seem to be clinically significant. Isolated subtalar fusion for lesions limited to the subtalar joint, which includes talocalcaneal bars, is a satisfactory method of treatment.