Search

Hyperphalangism is a rare congenital anomaly, with an extra phalanx between the phalanges in a finger. About 100 cases have been recorded in the literature. We report 42 cases in six generations of a family with various manifestations.

Trapezio-lunate external fixation for scaphoid fractures has been investigated experimentally and clinically. Six below-elbow fresh amputation specimens in which proximal, waist and distal scaphoid fractures were created, displaced, reduced and externally fixed were used for an experimental study and after 10,000 extension-flexion movements of the wrist, no displacement was observed. A strain-gauge study confirmed the strains at the fracture site. Seven patients were treated in this way. No immobilization was necessary and all patients returned to their regular employment within 3 days and all fractures were united without displacement. The technique overcomes certain disadvantages of plaster fixation and internal fixation of scaphoid fractures.

PubMed: 8042494, I modified a technique of talectomy reported previously for osteoporotic cases. A larger medial malleolar fragment is displaced laterally to prevent the bone from being splintered during fixation. 2 Hawkins Group III fracture-dislocations of the talus and 4 equinovarus feet were successfully treated by this technique

The role of an anomalous tibialis posterior (TP) tendon in the etiology of hallux valgus (HV) deformity was investigated in four stages: clinical, anatomical, neurological, and operative. In the clinical stage, the patients were instructed to planter flex and invert the foot to contract the TP tendon. Attempts to correct the deformity passively were not possible and resulted in, moderate pain in all patients (197 feet). When the foot was in dorsiflexion and everted (TP tendon was relaxed) the deformity was easily corrected without any pain in 196 feet (99.5%). In the second stage (anatomical), 10 cadavers (20 feet) with HV deformity and 10 cadavers (20 feet) without any foot deformity were dissected. An abnormal expansion of TP tendon into the oblique part of adductor hallucis was found consistently in all HV feet. The tendinous expansion was absent in all normal feet studied. Also when traction was applied to TP tendon, an increase in the metatarsophalangeal (MP) angle of the big toe was observed in all HV feet, but not in the control group. In the third group (neurological), faradic stimulation was applied to the TP muscle in 7 patients with HV deformity and 7 without deformity. The MP angle was increased in HV patients, but no change was observed in the control group. In the fourth stage, 11 patients (18 feet) surgically operated for HV deformity by proximal metatarsal osteotomy and excision of the band anchoring TP tendon to the oblique part of adductor hallucis. The results were excellent in 10 patients (17 feet) even after a minimum 2.5 year follow-up. Also, in two patients who were operated by different procedures with poor results, the TP tendon was lengthened by Z-plasty and they were completely pain free. Our data show the dynamic role of anomalous expansions of the TP tendon into the oblique part of adductor hallucis muscle in HV patients. We suggest this expansion be excised in addition to other operative procedures selected for the surgical treatment of HV patients. © 1994 Wiley-Liss, Inc.

WOS: A1993ME54900010, PubMed ID: 8261652, We report five members of a family with dacryocystitis associated with osteopoikilosis. The inheritance is autosomal dominant. Review of the literature revealed no other report of this kind of association. Osteopoikilosis must not be considered as a coincidental radiographic finding but as part of a systemic disorder.

PubMed: 8421039, We report a new technique of talectomy for patients with Hawkins group III fracture-dislocation of the talus. Talectomy is performed through a medial incision, the foot is displaced anteriorly, and the fractured or osteotomised medial malleolus is moved laterally and fixed to the tibia with a malleolar screw. Full weight-bearing is allowed after six weeks. In four patients at 36 to 57 months after operation the results were excellent in three and good in one, with no pain or early evidence of degenerative arthritis in the remaining joints of the foot.

A case of osteonecrosis of the accessory navicular bone is reported. This entity should be kept in mind in the differential diagnosis of painful accessory navicular.

A retrospective analysis of 434 patients with vertebral tuberculosis who were treated surgically was performed with special reference to the preoperative duration of chemotherapy. Of these, 376 underwent 4 weeks of a chemotherapy regimen with isoniazid, rifampin and ethamburol, and in 2 re-activation of the disease was observed. The remaining 58 underwent operation for neurological impairment with 6–18 h of the same chemotherapy regimen, and in no case did re-activation occur. These results suggest a shorter duration of chemotherapy may be utilised in all patients undergoing surgical treatment for vertebral tuberculosis, providing a thorough debridement is performed, leaving no necrotic or infected tissue behind.

The accessory navicular bone is one of the most symptomatic bones of the foot. Although it has been reported:to be present in various members of the same family, there is a lack of knowledge about its inheritance in the literature. We examined three families and suggest that it has an autosomal dominant trait with incomplete penetrance.

[The authors respond:] We thank Pierre Juery for his interest in our report on avascular necrosis of the femoral heads.[1][1] We would like to clarify the chronology of events: the patient's symptoms appeared 8 months after the corticosteroid injection; the MRI scan was done 5 months after the