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Background: In Ayurveda, Manyastambha is defined as Manyahakriyahani. It is the clinical entity in which the back of the neck becomes stiff, and the neck movement is impaired. Manyastambha is explained one of the Vataja Nanatmaja Vikara by Acharyas. Manyastambha occurs in Urdhwajatru pradesha. It can be correlated with cervical Spondylosis in modern medicine. Cervical Spondylosis is a condition in which degenerative changes are found in the cervical spine. The bony overgrowth of adjacent vertebrae is usually associated with age-related changes in intervertebral discs. In today's era, because of stressful and fast lifestyle, people suffering from various degenerative diseases. Manyastambha is one of the lifestyle disorders which is caused due to excessive use of motor vehicle, travelling, constantly sitting and functioning for a longer duration, lifting heavy weights, lack of exercise or yogas, taking unhealthy foods. Ruk (pain) and Stambha (stiffness) are the main symptoms of Manyastambha. So to prevent the increasing rate of Manyastambha patients, we need to rule out the exact cause from the Nidanas given by Acharyas and correlate it with cervical Spondylosis. Manyastambha (Cervical Spondylosis) is one of the most everyday orthopaedic problems faced by the primary problem. Aim: Studying Nidan (etiological factors) responsible for Manyastambha concerning cervical Spondylosis in the present era. Methods: This study will be observational; subjects mainly diagnosed for manyastambha will be recruited in this study and observe the causative factors responsible for that particular subject. Results: The Result will be based on observation and analyzed data. Conclusion: The Nidana, which are most likely to cause Manyastambha in patients, provides proper guidelines to the patients.

In this work, we sought to delineate the prevalence of cardiothoracic imaging findings of Proteus syndrome in a large cohort at our institution. Of 53 individuals with a confirmed diagnosis of Proteus syndrome at our institution from 10/2001 to 10/2019, 38 individuals (men, n = 23; average age = 24 years) underwent cardiothoracic imaging (routine chest CT, CT pulmonary angiography and/or cardiac MRI). All studies were retrospectively and independently reviewed by two fellowship-trained cardiothoracic readers. Disagreements were resolved by consensus. Differences between variables were analyzed via parametric and nonparametric tests based on the normality of the distribution. The cardiothoracic findings of Proteus syndrome were diverse, but several were much more common and included: scoliosis from bony overgrowth (94%), pulmonary venous dilation (62%), band-like areas of lung scarring (56%), and hyperlucent lung parenchyma (50%). In addition, of 20 individuals who underwent cardiac MRI, 9/20 (45%) had intramyocardial fat, mostly involving the endocardial surface of the left ventricular septal wall. There was no statistically significant difference among the functional cardiac parameters between individuals with and without intramyocardial fat. Only one individual with intramyocardial fat had mildly decreased function (LVEF = 53%), while all others had normal ejection fraction.

Condylar hyperplasia (CH) is an overgrowth disorder of the temporomandibular joint bones caused by growth center overactivity of the mandibular condyle. Although the disorder is mostly idiopathic, several etiologies have been proposed. CH presents as progressive facial asymmetry with functional abnormalities. A combination of clinical, histopathological, and radiological findings is crucial to determine the diagnosis. Several diagnostic algorithms have been described in the literature. Management of CH is variable and depends on the growth of the bone. Here, we present the case of a 36-year-old female who presented with progressive facial asymmetry which was diagnosed as unilateral CH with active bony overgrowth.

The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia.Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3-C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter.Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases.

Miniplate osteosynthesis has revolutionised the treatment of open reduction and internal fixation in craniomaxillofacial procedures. However, when complications arise necessitating the removal of previously placed miniplates, bony overgrowth may be present and must be eliminated before removal of the hardware is possible. Osteogenesis over the screws prevents proper engagement of the screwdriver with the screw drives. If bone remains embedded in the screw drive during attempted removal of the screw, the contact interference increases the risk of the screwdriver slipping and the screw drive being stripped. There remains a lack of adequate techniques to clear bony overgrowth from miniplates and screws to allow for easy removal, as conventional methods are ineffective, time-consuming, and may damage the screw drives. Herein, we describe a new laser-assisted miniplate removal technique to eliminate bone that has grown over miniplates and screws before the miniplate is removed. This technique is efficient, safe, and simple and, compared with conventional methods, may decrease the complications associated with the removal of miniplates and screws.

Background Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural spinal cord stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. Methods Six female juvenile pigs underwent surgical investigation. One control animal underwent a laminectomy only, whereas the 5 other animals had implantation of an intradural SCS prototype. One of the prototypes was fully wired to enable acute stimulation and concurrent electromyographic recordings. All animals underwent terminal surgery 3 months postimplantation, with harvesting of the spinal column. Imaging (microcomputed tomography scan) and histopathologic examinations were subsequently performed. Results All animals survived implantation without evidence of neurologic deficits or infection. Postmortem imaging and histopathologic examination of the spinal column revealed no evidence of spinal cord damage, cerebrospinal fluid fistula formation, abnormal bony overgrowth, or dural defect. Viable dura was present between the intra- and extradural plates of the device. Electromyographic recordings revealed evoked motor units from the stimulator. Conclusions Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans.

Background: The purpose of this study was to report the surgical treatment experience of patients with amniotic constriction bands (ACB) over a 35-year interval and detail consequential limb deformities with emphasis on hands and upper extremities, along with the nature and frequency of their surgical treatment methods. Methods: Fifty-one patients were identified; 26 were males and 25 females. The total number of deformities was listed. The total number of operations, individual procedures, and operations plus procedures that were done for each patient and their frequency were recorded. Results: The total number of operations was 117, and total number of procedures was 341. More procedures were performed on the upper extremity (85%) than the lower extremity (15%). Including the primary deformity ACB, 16 different hand deformities secondary to ACB were encountered. Sixteen different surgical methods for the upper extremity were utilized; a primary procedure for ACB and secondary reconstructions for all secondary deformities. Average age at the time of the first procedure was 9.3 months. The most common procedures performed, in order of frequency, were excision of ACB plus Z-plasty, release of partial syndactyly, release of fenestrated syndactyly, full-thickness skin grafts, resection of digital bony overgrowth from amputation stumps, and deepening of first and other digital web spaces. Conclusions: Many hand and upper extremity deformities secondary to ACB are encountered. Children with ACB may require more than one operation including multiple procedures. Numerous surgical methods of reconstruction for these children’s secondary deformities are necessary in addition to the customary primary procedure of excision of ACB and Z-plasty.

Lipomatosis of nerve (LN) is a rare disorder of peripheral nerves that produces proliferation of interfascicular adipose tissue. It may be associated with soft-tissue and bony overgrowth within the affected nerve territory. LN has been almost exclusively reported in appendicular peripheral nerves; the median nerve at the wrist and palm is among the most common locations. The authors present a new pattern of LN that shows circumferential proliferation of fat around the epineurium of the nerve. They believe that this case and the two other documented examples in the literature (also affecting cervical and thoracic spinal nerves) share the same new pattern of LN. Defining the full spectrum of adipose lesions of the nerve and establishing a cause-effect relationship with nerve-territory overgrowth disorders may offer options for future management through targeted nerve lesioning.

Implantation of auditory osseointegrated implants, also known as bone-anchored hearing systems (BAHS), represents a surgical option for select pediatric patients aged 5 years or older with hearing loss. Functional indications in this patient population include conductive or mixed hearing loss. Common complications of implantation include skin infections, chronic skin irritation, hypertrophic skin overgrowth, and loose abutments. In a case series of 15 pediatric patients, we discovered an unexpectedly high skin-related complication rate requiring surgical revision of 53%. During revision surgery, we discovered 5 patients who exhibited significant bony overgrowth at the abutment site, a complication infrequently noted in past literature.

Introduction: Our primary intention is to review the literature that has been published in this field and to report some cases of surgical correction of facial and skeletal deformities in patients with thalassemia. Thalassemia is widespread, and about 5% of the world population is affected. Management of facial and skeletal deformity is a major concern in patients with thalassemia, and numerous surgical approaches have been advocated to correct facial deformities, although the type of treatment remains in dispute. Materials and Methods: We report the cases of 3 specific patients who were treated with uncommon surgical procedures after the hematologic condition was corrected. Results: No signs of relapse or maxillary bony overgrowth have occurred in these patients. No massive bleeding occurred during the procedures, and the patients tolerated the surgical approach very well. Complicated surgical procedures, such as bimaxillary segmental osteotomies with 2 or more pieces have been done in patients who had proper systemic conditions without any complications. Conclusions: Maintaining a hemoglobin level of approximately 10 g/dL decreases the risk of preoperative hemorrhage and complications of anesthesia. A complicated surgical approach and more instability during surgery is expected in patients with higher degree of systemic problems. We found that preoperative facial analysis was important in guiding our surgical planning and would benefit the cosmetic outcome as well. Attention to cardiac dysfunction, osteoporosis, vitamin D deficiency, and type of hemoglobin deficiency must be kept in mind, though more surgical cases must be treated before reaching a definitive conclusion.

Congenital nasal pyriform aperture stenosis (CNPAS) is an unusual cause of upper airway obstruction that may happen because of respiratory distress, cyclic cyanosis or feeding problems. Bony overgrowth of maxillary nasal process sounds responsible for this deformity. Diagnosis is based on clinical evidence and radiologic findings. Failure to conservative management, respiratory distress and feeding problems are all indications of surgical treatments. In our experience, the sublabial approach is known as the most effective to these patients at any age. Otolaryngologists and pediatricians should therefore consider CNPAS as a rare but treatable cause in the patients with upper respiratory problems.

Background: It has been reported that relative to other sports participants, ice hockey players suffer from cam-type femoroacetabular impingement (FAI) in higher numbers. α angles have been reported to increase with the likelihood of symptomatic FAI. It is unclear how prevalent increased α angles, commonly associated with cam FAI, are in asymptomatic young ice hockey players. Hypothesis: There would be a higher prevalence of α angles associated with cam FAI in youth ice hockey players than in a non–hockey-playing (skier) youth control group. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 61 asymptomatic youth ice hockey players (aged 10-18 years) and 27 youth skiers (controls) (aged 10-18 years) underwent a clinical hip examination consisting of the flexion/abduction/external rotation (FABER) distance test, impingement testing, and measurement of hip internal rotation. The hip α angle was measured by magnetic resonance imaging, and labral tears and articular cartilage lesions were documented. Hockey players were grouped according to their USA Hockey classification as peewees (ages 10-12 years), bantams (ages 13-15 years), and midgets (ages 16-19 years). Results: Overall, ice hockey players had significantly higher α angles than did the control group, and hockey players had a significant correlation between increased age and increased α angles, while the control group did not. In the ice hockey group, 75% had an α angle of ≥55°, while in the skier group, 42% had an α angle of ≥55° ( P < .006). Hockey players were 4.5 times more likely to have an α angle commonly associated with cam impingement than skiers. Midget players had the highest risk of increased α angles. Conclusion: Even at young ages, ice hockey players have a greater prevalence of α angles associated with cam FAI than do skier-matched controls. Properties inherent to ice hockey likely enhance the development of a bony overgrowth on the femoral neck, leading to cam FAI.

Paget’s disease of bone is a disorder of focal bone remodeling that occurs in the adult skeleton, and that increases in prevalence with aging. The natural history of Paget’s disease of bone is the progression of bony overgrowth and deformity, with most complications arising from these ‘…changes of shape, size and direction of the diseased bones’ (Sir James Paget 1877). There has been considerable interest in the morbidity and mortality of patients with Paget’s disease of bone, and studies addressing these issues, as well as the evaluation and treatment of Paget’s disease, will be the focus of this review. A brief review of the epidemiology and a case study will be used to illustrate specific issues arising in the evaluation and treatment of patients with Paget’s disease of bone.

Congenital nasal pyriform aperture stenosis is a rare cause of nasal obstruction in the neonate. This condition is caused by a bony overgrowth of the median nasal process of the maxilla. An appropriate workup includes evaluation for associated anomalies and fine-cut CT. Surgical treatment is indicated in patients with respiratory difficulty or poor weight gain.

Klippel-Trenaunay syndrome (KTS) is a congenital disorder characterized by a triad of (1) capillary malformations, (2) venous malformations, and (3) soft tissue or bony hypertrophy. There exists one report of a patient with KTS and an associated sensorineural hearing loss. We describe an adolescent girl with KTS and AV fistulas who was found to have a bony overgrowth extending from the cochlea into the middle ear cavity and an ipsilateral mixed hearing loss. In both of these patients, there were obvious KTS deformities involving the face. We suggest conducting hearing screening in patients with KTS and obvious head involvement.

Moose (Alces alces) are known to suffer from a wide range of diseases including osteoarthropathies. An Alces specimen collected in 1989 from Summit County, Utah shows four separate occurrences of osteoarthropathy: 1) extensive remodeling of the fifth and sixth cervical vertebrae and lesser changes in the other cervical vertebrae; 2) massive bony overgrowth on the right calcaneus, whereas the left calcaneus appears free of disease; 3) osteoarthritis in the weight-bearing joints of the pelvis; and 4) a fracture in the right femur. The osteoarthritis in the weight-bearing joints is not atypical for an individual of its age, estimated at 6.0 to 7.5 years. However, infection is a more likely cause for the changes to the bones in the neck and hock. Trauma in the hind limb would be necessary to have caused the fracture in the femur. This individual lived with its ailments long enough for the architecture of its bones to be dramatically affected. Present-day northern Utah is an ecosystem with a paucity o...

Background It has been reported that relative to other sports participants, ice hockey players suffer from cam femoroacetabular impingement (FAI) in higher numbers. Alpha angles have been reported to increase with the likelihood of symptomatic FAI. It is unclear how alpha angle and other factors related to FAI change over early childhood years. Objective Track youth hockey players over 5 years and determine if factors associated with FAI increased as they aged and increased skating time. Design Screening. Setting Youth club. Patients (or Participants) 16 asymptomatic youth ice hockey players. All players started in the peewee(ages 10 to 12) division and moved up in divisions over the 3 years. Interventions (or Assessment of Risk Factors) Clinical hip examination consisting of the FABER test, impingement testing, and measurement of hip internal rotation. An MRI was taken and the hip alpha angle was measured and labral tears were documented. Main Outcome Measurements Alpha angle and labral tear on MRI Results These youth hockey players played an average of 42 weeks/year Players had significantly increased alpha angle by year 3 of screening. The average alpha angle at year 1 was 56(range 45 to 63), year 2 was 59 (range 52 to 68), year 3 was 75 (range 64 to 88), year 4 was 75 and year 5 was 78. By year 5, 14/16 had asymptomatic labral tears. There were no significant changes in internal rotation over the 5 years. There was a trend toward decreased internal rotation in goalies. Conclusions Young ice hockey players show increasing alpha angles and development of asymptomatic labral tears. Stresses inherent to ice hockey likely enhance the development of a bony overgrowth on the femoral neck contributing to cam FAI.

Objective: Intra-lesional bony overgrowth (BO) identified during or following cartilage repair treatment is being frequently described through subjective reports focusing primarily on incidence. Our objective was to quantify the exact volume of intra-lesional BO at 12 months post-cartilage repair treatment, to determine if a correlation exists between the extent of BO and clinical outcomes, and to visualize and characterize the BO. Design: MRI scans were systematically obtained during a randomized clinical trial for cartilage repair (Stanish etal., 2013) that compared two microfracture-based treatments in 78 patients. Semi-automated morphological segmentation of pre-treatment, 1 and 12 months post-treatment scans utilizing a programmed anatomical atlas for all knee bone and cartilage structures permitted three-dimensional reconstruction, quantitative analysis, as well as qualitative characterization and artistic visualization ofBO. Results: Limited intra-lesional BO representing only 5.8±5.7% of the original debrided cartilage lesion volume was found in 78 patients with available MRIs at 12 months. The majority (80%) of patients had very little BO (

The aim of this study was to measure quantitatively and to analyze the process of condylar restoration during and after functional appliance therapy with an activator in children and juveniles who had sustained condylar fractures. Spiral computed measurement of condylar morphology was performed in order to quantify the association described in the literature between condylar remodelling and age as well as certain types of fracture. Nineteen patients with an average age of 13.4 years, who had sustained a functionally treated unilateral condylar fracture 4.9 years earlier on average, were included in the present study as the follow-up group. Twenty patients, who had sustained a unilateral fracture at an average age of 8.1 years and had been treated functionally for 6 to 8 months, formed the treatment group. The condylar dimension and the condylar neck length of the ipsilateral and of the contralateral temporomandibular joints were measured from the axial and parasagittal reconstructions and were compared on the basis of sex, age and fracture type. The mediolateral condylar dimension of the follow-up group showed a sex-specific difference of 0.2 cm on the contralateral side and 0.4 cm on the ipsilateral side. The fracture side condyle indicated a relative mediolateral decrease of 4.2% and an anteroposterior increase of 12.6%. Shortening of the condylar neck and excessive bony overgrowth were found to occur more often in fractures with displacement and in low fracture types. The “10-plus” subgroup at time of trauma showed a significantly greater variation and greater differences in mediolateral and anteroposterior condylar dimension than the younger patients.

The aim of this study was to measure quantitatively and to analyze the process of condylar restoration during and after functional appliance therapy with an activator in children and juveniles who had sustained condylar fractures. Spiral computed measurement of condylar morphology was performed in order to quantify the association described in the literature between condylar remodelling and age as well as certain types of fracture. Nineteen patients with an average age of 13.4 years, who had sustained a functionally treated unilateral condylar fracture 4.9 years earlier on average, were included in the present study as the follow-up group. Twenty patients, who had sustained a unilateral fracture at an average age of 8.1 years and had been treated functionally for 6 to 8 months, formed the treatment group. The condylar dimension and the condylar neck length of the ipsilateral and of the contralateral temporomandibular joints were measured from the axial and parasagittal reconstructions and were compared on the basis of sex, age and fracture type. The mediolateral condylar dimension of the follow-up group showed a sex-specific difference of 0.2 cm on the contralateral side and 0.4 cm on the ipsilateral side. The fracture side condyle indicated a relative mediolateral decrease of 4.2% and an anteroposterior increase of 12.6%. Shortening of the condylar neck and excessive bony overgrowth were found to occur more often in fractures with displacement and in low fracture types. The "10-plus" subgroup at time of trauma showed a significantly greater variation and greater differences in mediolateral and anteroposterior condylar dimension than the younger patients.

Congenital nasal pyriform aperture stenosis has been described as an unusual cause of neonatal nasal obstruction. Clinical suspicion is based on respiratory distress, cyclic cyanosis, apneas, and feeding difficulties. A bony overgrowth of the maxillary nasal processes is thought to be responsible for this deformity. This anomaly has been reported as an isolated feature or can be associated with craniofacial or central nervous system anomalies. Surgery is indicated in cases of severe respiratory distress, feeding difficulties, and when conservative methods fail.

Craniometaphyseal dysplasia (CMD) is a rare congenital bone disorder with facial dysmorphism developing from early childhood. We describe an unusual case of CMD unnoticed until the patient was 19 years old. Her disorder was diagnosed for the first time from her facial nerve paralysis, and was treated with high-dose corticosteroids. This report indicates the need for extreme caution in dealing with facial nerve paralysis since early detection and accurate diagnosis is important in the treatment of bone diseases. High-dose corticosteroid could be effective in treating facial nerve paralysis, even when nerves have been directly constricted by a bony overgrowth.

Seventeen children aged newborn to 14 years underwent major through-bone amputations or revision at our two institutions. Ten patients (group 1) had primary autogenous epiphyseal transplants taken from the amputated limb and used to cap the open medullary canal of the residual limb. Seven patients (group 2) did not have epiphyseal transplants. Nine of 10 patients in group 1 (90%) had no problems related to bone overgrowth or delay in prosthetic fitting. In group 2, six of seven patients (86%) had clinically symptomatic bony overgrowth of 20 months after the index amputation on the average. Four patients had surgical revisions. Therefore, provided healthy autogenous donor epiphyses are available, we recommend primary epiphyseal transplants to avoid the complications of bone overgrowth in childhood through-bone amputations.

In patients with severe quadriplegic cerebral palsy and painful hip dislocation proximal femoral resection arthroplasty can reduce pain, but the risk of heterotopic ossification is significant. We present a surgical technique of autologous capping of the femoral stump in order to reduce this risk, using the resected femoral head as the graft. A retrospective study of 31 patients (43 hips) who had undergone proximal femoral resection arthroplasty with (29 hips) and without autologous capping (14 hips) was undertaken. Heterotopic ossification was less frequent in patients with autologous capping, and a more predictable pattern of bony overgrowth was found. For a selected group of non-ambulatory patients with long-standing painful dislocation of the hip, we recommend femoral resection arthroplasty over more complicated reconstructive operations. The risk of heterotopic ossification, which is a major disadvantage of this operation, is reduced by autologous capping.

It is striking that evidence for hyperostosis frontalis interna - a phenomenon of exclusive bilateral thickening of frontal endocranial surface - in archaeological samples is very rare in contrast to its modern prevalence. Because microevolutionary changes have been shown for various human characteristics any alteration of hormonal levels is very likely. Selection pressure was definitively higher in earlier times. This favoured prolonged alertness in order to access sufficient food, shorter feeling of satiety, lower level of fat metabolism, lower metabolic rates and, therefore, lower level of leptin - a 167 amino acid peptide mainly involved in human total body fat regulation. Its effects on bone metabolism are still debated. Nevertheless, we postulate the following hypothesis: In humans a decrease of selective pressure favoured an increased metabolic rate. This, being related to the higher level of leptin caused an increase of localized bony overgrowth like hyperostosis frontalis interna.

Congenital lipomatous overgrowth, vascular malformations, and epidermal nevi (CLOVE) syndrome is a recently described syndrome similar to Proteus syndrome but lacking the progressive or distorting bony overgrowth of Proteus syndrome. We describe a neonate with features of CLOVE syndrome and nevus unius lateris.

To our knowledge, this is the first description of the histopathology of the temporal bone from a case of craniodiaphyseal dysplasia. The air spaces of the mastoid, external auditory canal, and middle ear cavity are reduced by hyperostotic bone. The ossicles are also deformed by the bony overgrowth. Anomalous ossicles with hyperostosis could affect the air conduction. Even though the internal auditory canal is somewhat elongated and narrow, no labyrinthine abnormalities can be attributed to the abnormal bone. Facial nerves run through abnormal courses but the geniculate ganglion cells are not involved. The VIIIth nerve dysfunction in this case could be due to mechanical damage of the nerve fibers and/or impaired vascular supply by the hyperostosis.

Autologous stump capping is a procedure designed to prevent bony overgrowth in skeletally immature amputation stumps. All 19 capping procedures in the lower extremities were successful after an average follow-up of 7.3 years. All patients use their prostheses, and no secondary operations have been needed for stump problems. Of the 31 cap-plasties of the humerus, six required re-operation. The overall failure rate of 12% is low compared with the failure rate of re-amputation.

Dysplasia epiphysealis hemimelica (DEH), known as Trevor’s disease, tarsoepiphyseal aclasis or la tarsomegalie, is a rare disease characterized by cartilaginous overgrowth of one-half of a single limb. Until now only three cases have been reported in Korea. The ages at initial diagnosis were 2.3 years, 2.5 years and 11.5 years, and patients were two boys and one girl by sex. The chief complaints were genu valgum (2 cases) and valgus of the foot (1 case). Plain radiographs showed bony overgrowth and asymmetrical ossification centers in all cases. MRI showed a definite cartilaginous or osteocartilaginous lesion (T1-weighted: intermediate signal intensity (SI) and T2-weighted: intermediate SI mixed inner high SI). Arthroscopic removal of the loose body was performed in one case and spontaneous regression of the genu valgum was noted in one case. We report upon three additional cases and review the literature.

Thirty-four cases of RM isoelastic total hip arthroplasty were followed for an average period of 42 months after surgery. Eleven (32%) were revised because of purely mechanical loosening of the femoral stem. Of the remaining cases, 16 (69%) had poor Mayo hip scores and only 2 (9%) had good results. Radiologic evidence of loosening of the uncemented femoral stem, as exemplified by radiopaque lines within radiolucent zones, the so-called “pedestal sign” of increased density at the stem tip, and proximal bony overgrowth around the collar were present in all 11 cases that were revised. Marked stem shift and localized cortical hypertrophy were noted in nine revised cases. Radiopaque lines were observed in 11 nonrevised cases, all with poor Mayo hip scores.

Four members of one family had craniometaphyseal dysplasia. Two of the four had severe optic atrophy with profound loss of vision as a complication of this disorder. Optic nerve decompression attempted in one patient may have caused a reduction in the vision of that eye. Eight years later this patient underwent craniofacial surgery uneventfully for contouring of her facial and cranial bones, but osteotomies and intracranial surgery were specifically avoided because of bony over-growth in the foramen magnum region.

Lesions of the costovertebral (CV) and costotransverse (CT) joints are distinctly unusual in rheumatoid arthritis. The patient presented had dramatic changes in these joints with destruction, ankylosis, and bony overgrowth. This led to a moderate respiratory impairment and a distinctive radiological presentation.

Congenital nasal pyriform aperture stenosis is an unusual and previously undescribed cause of nasal airway obstruction in the newborn. The nasal pyriform aperture is narrowed due to bony overgrowth of the nasal process of the maxilla. This anomaly may produce signs and symptoms of nasal airway obstruction in newborns and infants similar to those seen in bilateral posterior choanal atresia. Computed tomography confirms the diagnosis and delineates the anomaly. A series of six patients with nasal pyriform aperture stenosis is presented. Four patients were treated with surgical enlargement of the nasal pyriform aperture via a sublabial approach. One patient was repaired via a transnasal approach, and one patient did not undergo surgical intervention. Follow-up reveals normal nasal airway and facial growth in all patients. Mildly symptomatic patients with congenital nasal pyriform aperture stenosis may be treated expectantly, while severely symptomatic patients benefit from repair via the sublabial approach.

A complete history and physical examination are essential in the initial evaluation of a child with a limb deficiency and/or amputation. Fortunately, most limb-deficient/amputee children are normal in all respects except for their limb problem.

Orthopedic surgeons dread the complications of chronic osteomyelitis. Infection in bone can persist, despite thorough debridement, sequestrectomy, saucerization, and long-term systemic antibiotic therapy.

Osteoarthritis (OA) is a common systemic disorder characterized in humankind by painful, stiff, swollen joints that show cartilage loss and bony overgrowth of radiographic examination. X-rays show joint space narrowing, bony eburnation, osteophytes and bony spurs. The joint with OA is usually bony hard with irregular knobby contours and somewhat limited in motion. Cartilage loss and osteophyte formation are usually detected simultaneously but either may precede the other. The presence of these characteristic radiographic changes in the joints without clinical symptons is considered physiologic degeneration and does not warrant the diagnosis of OA which is a disorder characterized by both signs and symptoms.

Sir James Paget first brought to prominence a definite and unexplained type of bone disease that has rightly been classified under his name, though the Germans later named it "osteomyelitis fibrosa"— a name that is clinically delusive, as there is nowhere a fibrous change, but only a large bony overgrowth. Genetically, bone structure is classed with fibrous tissue in embryologic development; but it is not an excuse for a name that is misleading and not elucidating to the student. Though the disease appears first in some isolated bone, it is not essentially a "one-bone disease." Usually it is noticed in a curvature and enlargement of one tibia, femur, clavicle or ulna; and the surgeon often examines the skeleton in vain endeavor to find a second diseased bone. Nevertheless, in almost all cases, a roentgenogram of the head will reveal a thickening of the frontal, parietal and occipital bones, sometimes of