Cases reported "Clubfoot"

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1/26. Unilateral tibial hemimelia with leg length inequality and varus foot: external fixator treatment.

    A 15-year-old girl with type II unilateral hemimelia presented with a 13.5-cm shortening of her right leg, absence of the distal half of the tibia, tibiofibular synostosis, and medial dislocation of a cavus and varus foot. She was treated by means of an external fixator. The shortening was significantly corrected, and realignment of the foot with the limb was achieved. An arthrodesis of the talus and lower end of the fibula was carried out operatively and stabilized with an external fixator. In the same surgical procedure, we performed an osteotomy of the tibiofibular synostosis, and progressive distraction was done with another external fixator. We emphasize the advantages of progressive distraction for the correction of congenital deformities of the limbs.
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ranking = 1
keywords = operative
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2/26. Confirmation of arterial deficiencies in a limb with necrosis following clubfoot surgery.

    This study describes postoperative necrosis of the hallux and first ray in a child with clubfoot. Arteriography performed on this child's lower limbs demonstrated, in the operated leg, hypoplasia of both the anterior and posterior tibial arteries and failure of the dorsalis pedis artery to traverse the tarsus and complete the deep plantar arch. Previously, congenital vascular deficiency was suggested to predispose such operated limbs to necrosis. These findings confirm the association between vascular deficiency and necrosis. In this present study, the metabolic demands of wound healing were sufficient in a limb with vascular deficiency to cause localized distal hypoperfusion leading to cyanosis and necrosis of the hallux and medial foot.
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ranking = 1
keywords = operative
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3/26. Psychogenic equinovarus: the importance of recognition and non-operative treatment.

    Although the potential for musculoskeletal symptoms in hysteric conversion disorder was recognized by Sigmund Freud, reports of it in the orthopaedic literature have been limited to upper extremity manifestations. This study reports 3 cases which illustrate hysteric conversion presenting as primary foot and ankle complaints. Given its relative rarity, it is a diagnosis that is easy to miss. Clinical clues to its diagnosis and accepted methods of treatment are discussed. It is important to realize that this condition arises from an unconscious conflict and does not represent a voluntary falsification of symptoms. As such, confrontational treatment is not generally successful.
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ranking = 4
keywords = operative
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4/26. magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method.

    Little information exists about the degree of efficacy of the several nonoperative treatments, such as manipulation and casting, used in correcting the pathology of the virgin clubfoot deformity. The steps in the correction of the displacements and anomalies of the skeletal components have never been visualized. The method reported to have the best long-term results is that of Ponseti. A magnetic resonance imaging protocol was devised to image the described chondroosseous abnormalities of the virgin clubfoot deformity and to illustrate the changes that occur with the Ponseti method of treatment. Scans were performed at the beginning of, in the middle of, and at the end of treatment. Images obtained with this protocol largely agree with postmortem studies of clubfeet. All of the major chondroosseous pathology could be visualized in vivo. With Ponseti treatment, all the abnormalities seen on the initial scans either improved markedly or corrected completely. Treatment resulted in correction not only of the abnormal relationships of the tarsal bones, but also of the abnormal shapes of the individual tarsal osteochondral anlages, probably because of the changes in growth resulting from the changes in mechanical loading of fast-growing tissues.
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ranking = 1
keywords = operative
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5/26. scoliosis in Gordon's syndrome.

    Gordon's Syndrome is described as an autosomal dominant condition with the characteristics of short stature, a stiff spine, camptodactyly (89%), cleft palate (27%) and club feet (73%). The authors present a case report of a patient with this rare entity complicated by an unusual complex spinal deformity. There are no prior reports in the literature concerning operative or nonoperative management of deformity in this patient population. scoliosis in Gordon's Syndrome shares the characteristics of an arthrogrypotic neuromuscular curve and demands extensive soft tissue release for optimal correction.
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ranking = 2
keywords = operative
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6/26. Combined anomalies of the palate in Mohr syndrome: is preoperative electromyography of the palate useful?

    The authors present a girl with typical characteristics of oral-facial-digital syndrome type II (Mohr syndrome) with a cleft soft palate and pendulous tongue nodules. Because of feeding difficulties, electromyography was performed of both morphologically identical halves of the soft palate. One half showed a normal muscle action potential and in the other half electrical silence was registered. Exploratory surgery during palatoplasty showed a fatty hamartoma in the half of the palate in which no electric potentials had been registered.
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ranking = 4
keywords = operative
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7/26. Rigid plantarflexion of all digits: a surgical correction.

    The authors present an unusual case of a 28-year-old male with a painful plantarflexion deformity of all toes on the right foot. Past medical history was contributory and unique in the etiology of the deformity. To date, this deformity has not been reported in the literature, and the authors describe their experience with its surgical management. The patient, now 10 months postoperative, is functioning without pain at his desired level.
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ranking = 1
keywords = operative
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8/26. Anesthesia and prader-willi syndrome: preliminary experience with regional anesthesia.

    The constellation of neonatal hypotonia, developmental delay, hypogonadism and obesity caused by hyperphagia was first reported in 1956 and subsequently termed prader-willi syndrome (PWS). Genetic analysis has demonstrated abnormalities of chromosome 15. Anesthesia concerns of PWS include morbid obesity, the potential for difficulties with airway management, risk for perioperative respiratory failure, abnormalities in the central control of ventilation and temperature, rare reports of primary myocardial involvement, aggressive and at times violent behavior and glucose intolerance. For the first time, we report the use of regional anesthesia in four patients with PWS. A lumbar plexus catheter was used to provide postoperative analgesia in one patient while regional anesthesia (fasica iliaca block, spinal anesthesia, and lateral vertical infraclavicular block) was used to provide primary intraoperative anesthesia in three other patients while avoiding the need for general anesthesia. Previous reports of the anesthesia care of patients with PWS are reviewed and the potential perioperative implications of the sequelae of PWS are discussed.
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ranking = 4
keywords = operative
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9/26. Anesthesia for sickle cell disease and congenital myopathy in combination.

    We report on the perioperative management of anesthesia and analgesia in a child with sickle cell disease and a congenital myopathy, presenting for corrective orthopedic surgery. The case illustrates two valuable points of interest: the many benefits of regional anesthesia in complex medical cases and the successful use of tourniquets in children with sickle cell disease.
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ranking = 1
keywords = operative
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10/26. hypertension after operative correction of club-foot deformity.

    Severe hypertension occurred as a postoperative complication after correction of a club-foot deformity in four children (seven feet) who were between the ages of two and three years and had no history of hypertension. The hypertension subsided slowly after administration of antihypertensive medications or more rapidly after release of the correction that had been obtained operatively.
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ranking = 6
keywords = operative
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