Bohler´s angle and the crucial angle of Gissane in paediatric population

Bohler angle and the crucial angle of Gissane are used on the evaluation of calcaneus fractures. However, few authors have described the variation of the angles when the calcaneus is growing. In this study, Bohler angle and the crucial angle of Gissane in paediatric population were measured using lateral foot radiographs of 429 patients, from 0 to 16 years of age. The control group was composed of 70 adult patients. The sample had a mean Bohler angle of 35.4° ± 5.9° and a mean crucial angle of Gissane of 110.5° ± 7.4°. The greater mean difference was identified for Bohler angle (8°) in the age group of 5 to 8 years (39.6° ± 5.7°) and for the crucial angle of Gissane (5°-6°) in the age group of 0 to 4 years (115.8° ± 7.3) (P < .05). The influence of the ossification centres on the geometry of the calcaneus across age groups makes Bohler angle and the crucial angle of Gissane higher in young children. The increase in Bohler angle points out the relative development of the posterior facet in young children and the importance of the reconstruction of the posterior facet height in the intra-articular calcaneus fractures

Late post-operative paraparesis after rib penetration of the spinal canal in a patient with neurofibromatous scoliosis

Rib displacement into the spinal canal is a rare cause of paraplegia or paraparesis in patients affected by neurofibromatous scoliosis. We describe a case of paraparesis in a 14-year-old child affected by neurofibromatous dystrophic kyphoscoliosis, treated with combined posterior and anterior spinal arthrodesis. Seventeen days after the surgical treatment the patient developed clinical signs and symptoms of paraparesis. A CT scan showed the head of the fifth rib protruding into the spinal canal with cord compression. Rib resection and posterior cord decompression were carried out following complete neurological recovery

Painful rib hump: a new clinical sign for detecting intraspinal rib displacement in scoliosis due to neurofibromatosis

BACKGROUND: Spinal cord compression and associate neurological impairment is rare in patients with scoliosis and neurofibromatosis. Common reasons are vertebral subluxation, dislocation, angulation and tumorous lesions around the spinal canal. Only twelve cases of intraspinal rib dislocation have been reported in the literature. The aim of this report is to present a case of rib penetration through neural foramen at the apex of a scoliotic curve in neurofibromatosis and to introduce a new clinical sign for its detection. METHODS: A 13-year-old girl was evaluated for progressive left thoracic kyphoscoliotic curve due to a type I neurofibromatosis. Clinical examination revealed multiple large thoracic and abdominal "cafe-au-lait" spots, neurological impairment of the lower limbs and the presence of a thoracic gibbous that was painful to pressure at the level of the left eighth rib (Painful Rib Hump). CT-scan showed detachment and translocation of the cephalic end of the left eighth rib into the adjacent enlarged neural foramen. The M.R.I. examination of the spine showed neither cord abnormality nor neurogenic tumor. RESULTS: The patient underwent resection of the intraspinal mobile eighth rib head and posterior spinal instrumentation and was neurologically fully recovered six months postoperatively. CONCLUSION: Spine surgeons should be aware of intraspinal rib displacement in scoliotic curves in neurofibromatosis. Painful rib hump is a valuable diagnostic tool for this rare clinical entity

Rib head protrusion into the central canal in type 1 neurofibromatosis

Intraspinal rib head dislocation is an important but under-recognized consequence of dystrophic scoliosis in patients with neurofibromatosis 1 (NF1). To present clinical and imaging findings of intraspinal rib head dislocation in NF1. We retrospectively reviewed clinical presentation, imaging, operative reports and post-operative courses in four NF1 patients with intraspinal rib head dislocation and dystrophic scoliosis. We also reviewed 17 cases from the English literature. In each of our four cases of intraspinal rib head dislocation, a single rib head was dislocated on the convex apex of the curve, most often in the mid- to lower thoracic region. Cord compression occurred in half of these patients. Analysis of the literature yielded similar findings. Only three cases in the literature demonstrates the MRI appearance of this entity; most employ CT. All of our cases include both MRI and CT; we review the subtle findings on MRI. Although intraspinal rib head dislocation is readily apparent on CT, sometimes MRI is the only cross-sectional imaging performed. It is essential that radiologists become familiar with this entity, as subtle findings have significant implications for surgical management

Thoracic solitary pedunculated osteochondroma in a child: a case report

Zubair Wali,1 Khalid I Khoshhal21Department of Orthopedic Surgery, King Fahd Hospital, Almadinah Almunawwarah, Saudi Arabia; 2Department of Orthopedic Surgery, College of Medicine, Taibah University, Almadinah Almunawwarah, Saudi ArabiaObjective: This case report describes the rare presentation of a thoracic pedunculated osteochondroma in a child, arising from the lamina of the fourth thoracic vertebra.Clinical features: A 7-year-old girl was referred for the evaluation of a swelling in her back. The patient was suffering from atraumatic, progressive painless back swelling, of approximately 2 years duration. The physical examination showed a healthy child, with a well-defined mass, about 4 &times; 6 cm, located around the midline of the upper thoracic spine. No clinical signs of hereditary multiple exostoses were detected. Plain radiographs and computerized tomography were suggestive of a pedunculated osteochondroma arising from the lamina of the fourth thoracic vertebra.Intervention and outcome: The patient underwent surgical excision of the mass. The pathologist confirmed the diagnosis. Follow up for 2 years did not show any evidence of clinical or radiological recurrence.Conclusion: The current report describes a rare case and the management of a solitary pedunculated osteochondroma arising from the lamina of the fourth thoracic vertebra in a child below the age of 10 years.Keywords: benign tumors, hereditary multiple exostoses, spine column tumors, thoracic vertebr

Closed anterolateral total talar dislocation: a case report and technical notes

Yousef A Alrashidi,1 Zubair A Wali,2 Khalid I Khoshhal11Department of Orthopedic Surgery, College of Medicine, Taibah University, 2Department of Orthopedic Surgery, King Fahd Hospital, Almadinah Almunawwarah, Saudi ArabiaBackground: Standard treatment of closed total talar dislocations (TTDs) is a controversial issue due to the rarity of the injury.Case presentation: We report a case of closed anterolateral TTD in a 30-year-old male treated successfully by a closed reduction technique with no radiological evidence of avascular necrosis on 1 year follow-up.Conclusion: Closed reduction has become the preferred modality of management of closed anterolateral TTD. This case supports, as found in recent literature, that closed reduction if possible in similar cases may yield a better outcome, although there is a need for high-level studies to prove the superiority of such a modality.Keywords: closed reduction, closed talar dislocation, complete talar dislocation, pantalar dislocation, talus, total talar dislocatio