Dynamic supination and hindfoot varus induced by chronic rupture of the tendons of both peroneus longus and brevis: a case report

Chronic rupture of both tendons of the peroneus longus and brevis is rare. Thus, it is difficult to diagnose and often overlooked.Since the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilizers, their rupture results in ankle sprain. We present a case with dynamic supination deformity during ambulation and hindfoot varus induced by chronic rupture of both tendons of the peroneus longus and brevis. We treated the patient with split anterior tibial tendon transfer and Dwyer calcaneal osteotomy. The dynamic supination deformity during ambulation and the hindfoot varus were improved, but a dorsal bunion remained, which was suggestive of residual dysfunction of the tendon of the peroneus longus

Measurement of femoral axial offset

Purpose to examine the accuracy and reproducibility of the femoral axial offset measured from the retrocondylar plane by computed tomography (CT). Bone specimens of the femur of 15 males and 15 females were analyzed. CT imaging was performed and data of the coordinates were collected (center of femoral head, center of an ellipse around greater trochanter, center of an ellipse around the base of femoral neck, posterior edge of great trochanter, and both posterior condyles). The angle between the line connecting center of the femoral head and center of an ellipse around greater trochanter and the line connecting both posterior condyles was set as anteversion 1. The angle between the line connecting the center of femoral head and center of an ellipse around base of the femoral neck and the line connecting both posterior condyles was set as anteversion 2. The femoral axial offset was measured from the retrocondylar plane. Measurements were performed three times on the same subject, and intrarater reliability (ICC) was determined. In addition, interrater reliability (ICC) was determined by comparing data from three raters. The mean value for anteversion 1 was 20.1° for males and 22.7° for females. The values for anteversion 2 were 16.0° and 19.9° for males and females, respectively. Offset was 34.0 and 33.4 mm in males and females, respectively. Intrarater ICC and interrater ICC exceeded 0.81 for both methods, suggesting that the method of measurement was reliable. Accuracy and reproducibility of the measurement of femoral axial offset from the retrocondylar plane were high

Immunohistochemical analyses of beta-catenin and cyclin D1 expression in giant cell tumor of bone (GCTB): A possible role of Wnt pathway in GCTB tumorigenesis.

Giant cell tumor of bone (GCTB) is a benign neoplasm but occasionally shows local recurrence, and histologically consists of osteoclast-like giant cells (GC) and stromal mononuclear cells (SC), which are capable of proliferation and osteoblastic differentiation. Activation of Wnt signaling can induce osteoblast differentiation and osteoclastgenesis during bone resorption process. This study analyzed the profiles of beta-catenin and cyclin D1 expression in GCTB to elucidate an involvement of Wnt pathway in tumorigenesis. We performed immunohistochemistry for beta-catenin, cyclin D1, and Ki-67 in 16 GCTB tumors, including 5 recurrent cases that were surgically resected. All 16 cases of GCTB displayed beta-catenin, cyclin D1, and Ki-67 expression. Immunoreactivity for beta-catenin was observed in nuclei of SC and GC. Cyclin D1 immunoreactivity was found mainly in nuclei of GC, while Ki-67 immunoreactivity was restricted to nuclei of SC. The nuclear beta-catenin labeling index (LI) in both SC (60.6 vs. 41.8%, p=0.074) and GC (41.7 vs. 20.1%, p=0.095) was higher in recurrent tumors than in primary tumors in all the 4 cases. However, Ki-67 LI in SC (18.8 vs. 19.9%, p=0.851) and cyclin D1 LI in GC (55.4 vs. 70.1%, p=0.225) were not higher in recurrent tumors than in primary tumors. Our results suggested activation of Wnt/ beta-catenin pathway in GCTB tumorigenesis. Since cyclin D1 in GC was never associated with the expression of the well-known proliferative marker Ki-67, cyclin D1 expression might play a role in GC formation instead of promoting cell proliferation during GCTB tumorigenesis. Importantly, it was suggested that the nuclear beta-catenin staining level might be associated with tumor recurrence in GCTB

Dynamic supination and hindfoot varus induced by chronic rupture of the tendons of both peroneus longus and brevis: a case report

Chronic rupture of both tendons of the peroneus longus and brevis is rare. Thus, it is difficult to diagnose and often overlooked. Since the peroneal tendons are the primary evertors of the foot and function as lateral ankle stabilizers, their rupture results in ankle sprain. We present a case with dynamic supination deformity during ambulation and hindfoot varus induced by chronic rupture of both tendons of the peroneus longus and brevis. We treated the patient with split anterior tibial tendon transfer and Dwyer calcaneal osteotomy. The dynamic supination deformity during ambulation and the hindfoot varus were improved, but a dorsal bunion remained, which was suggestive of residual dysfunction of the tendon of the peroneus longus

Femoral osteotomy to improve range of motion in residual deformity of perthes disease: A case report

Introduction: The treatment strategies for residual deformity of Perthes disease are not established. Case presentation: This is a case report of a 15-year-old boy. He developed right Perthes disease (lateral pillar classification group B) when he was 10 years old and underwent varus femoral osteotomy of the right side. At 12 years of age, he developed left Perthes disease (lateral pillar classification group B) and underwent varus femoral osteotomy of the left side. Postoperatively, he was treated with partial weight bearing of the left leg with crutches. At 15 years, range of motion (ROM) of his left hip was markedly limited at 30° flexion, 10° abduction, 70° external rotation, and ?20° internal rotation, and he was having difficulty maintaining a sitting position. Diagnosis: Stulberg group V was noted on plain radiography. Computed tomography (CT) showed collapse of the load-bearing part of the femoral head on the coronal plane, but the ball-shape was maintained in the posterior femoral head on sagittal and transverse sections. Intervensinos: Valgus-flexion-internal rotation osteotomy was performed to improve ROM. Outcomes: Left hip ROM improved to 90° flexion, 20° abduction, 50° external rotation, and 40° internal rotation immediately after the surgery. He was able to sit 10 months postoperatively but was left with a limp and limited ROM in the left hip at 60° flexion. Chondroplasty was performed during the plate removal surgery at 10 months postoperatively, which improved hip flexion to 100° immediately after the surgery. The patient was left with limited ROM of 60° flexion of the left hip at the final observation. Conclusion: Femoral osteotomy to improve ROM could be an option for residual deformity of Perthes disease