Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy

Fungi are unusual causes of pedal osteomyelitis in children and adolescents. Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi. A provisional diagnosis of foot mycetoma is made after clinical assessment. Radiologic-pathologic correlation is an essential supplement for the accurate diagnosis of osteoarticular infections. This paper aims to sensitize orthopedic surgeons, radiologists, and pathologists to the importance of correlative imaging findings in relation to surgical and microscopic pathology in osteoarticular infections, specifically eumycetoma osteomyelitis of the foot. From our review of the published data, the present case is the first report of radiologic-pathologic correlation in eumycetoma osteomyelitis of the calcaneus. This paper describes a case of eumycetoma osteomyelitis of the calcaneus in a child in which diagnostic X-rays and magnetic resonance imaging (MRI) were correlated with the surgical and microscopic pathologic features, for establishing an appropriate diagnosis and treatment. We conclude that there is a significant agreement between radiologic and pathologic evaluation for assessment of eumycetoma osteomyelitis of the calcaneus. Radiologic-pathologic correlation amplified our interpretation of imaging information available on plain radiographs and MRI and augmented diagnostic confidence. Similarly, anatomic-histopathological correlations consolidated diagnostic accuracy

Orthopaedic manifestations of Proteus syndrome in a child with literature update

Background: Proteus syndrome is a rare developmental disorder of unknown aetiology. It is a disorder characterized by postnatal overgrowth affecting multiple tissues. Proteus syndrome is most frequently manifested in skeletal changes. As manifestations of Proteus syndrome are highly variable, and many are found in other overgrowth syndromes, and due to inconsistent application of diagnostic criteria, the literature has more reports of patients misdiagnosed than correctly diagnosed. The purpose of this study is to report the clinical and radiographic patterns of affection of the musculoskeletal system in Proteus syndrome in the light of the proposed diagnostic criteria and cases reported in the literature. Methods: The clinical and radiographic musculoskeletal characteristics of a child with Proteus syndrome are illustrated along with a literature update. The orthopaedic manifestations in our patient are correlated to cases and proposed diagnostic criteria reported in the literature. Results: The study of the presented case and review of available literature show that there tends to be a highly characteristic pattern of skeletal abnormalities in Proteus syndrome. Conclusion: The rarity of Proteus syndrome and the variability of signs make the diagnosis challenging. Clinical and radiographic examinations are important contributors to the diagnosis. The clinical utility of the reported cases is significantly dependent on consistent application of diagnostic criteria that augment diagnostic accuracy. The present case reinforces the need for supplementary musculoskeletal imaging modalities to be implemented in the diagnosis of Proteus syndrome

Primary hyperparathyroidism in a child: The musculoskeletal manifestations of a late presenting rare endocrinopathy

AbstractPrimary hyperparathyroidism (PHPT) is rare in children and adolescents, but has greater morbidity in this age group. Most of these patients show predominantly skeletal pathology and to a lesser extent renal involvement. Osteopenia, osteoporosis and subperiosteal resorption are frequently encountered radiographic skeletal signs. This study describes the orthopedic manifestations of PHPT in a child. PHPT in this child exhibited a late presentation with significant clinical morbidity and extensive radiographic manifestations. The characteristic radiographic pattern of PHPT in childhood is an important contributor to the diagnosis. The radioclinical and biochemical correlations augment diagnostic accuracy and delineate extent of skeletal pathology

Reversal of skeletal radiographic pathology in a case of malignant infantile osteopetrosis following hematopoietic stem cell transplantation

Malignant infantile autosomal recessive osteopetrosis (ARO) is rare hereditable skeletal dysplasia characterized by a generalized osteosclerosis. ARO usually runs a fatal course in early childhood if untreated. Serious complications can arise from bone marrow suppression and pancytopenia. Hematopoietic stem cell transplantation (HSCT) is the only available treatment option that has been demonstrated to prolong life expectancy. Few publications with limited study participants have explored the employment of skeletal radiography to evaluate success of HSCT. We assessed the role of skeletal radiography as a tool to evaluate responsiveness to HSCT in a case of ARO with favorable short-term results

Open reduction internal fixation versus external fixation with limited internal fixation for displaced comminuted closed pilon fractures: A randomised prospective study

Background: Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and methods: Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results: The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion: Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence: Level II. 中文摘要: 背景: Pilon骨折涉及脛骨遠端關節面的圓頂。高能量Pilon骨折的最佳治療方法仍然存在爭議。 一些作者主張使用開放復位和內固定(ORIF)來避免關節不一致。 其他作者主張用橋接外固定和有限內固定(EFLIF)來減少軟組織並發症。 比較ORIF和EFLIF在高能量骨折中的放射臨床結局的前瞻性研究的文獻報導很少。 回顧性研究由於隨機化不足而有其局限性。 這項隨機前瞻性研究的目的是比較以ORIF或EFLIF治療移位的粉碎性閉合Pilon骨折Rüedi和Allgöwer II型和III型的臨床、放射學和功能結果。 材料與方法: 選擇42例患者進行研究。 二十二名患者接受了ORIF, 二十名患者接受了EFLIF。 我們使用美國骨科腳踝學會(AOFAS)評分作為報告踝關節臨床狀態的標準方法。 患者的臨床和放射學隨訪超過手術治療後兩年。 結果: ORIF和EFLIF治療高能量Pilon骨折的療效在短期內功能結局和並發症發生率方面同樣有效。 結論: 軟組織完整性和骨折粉碎似乎對手術結果有顯著影響。 具有較大樣本量的前瞻性多中心研究以控制其他相關變量和合併症是有必要的。 Keywords: external fixation, internal fixation, intraarticular ankle fractures, prospective, tibial plafon

A case of infantile osteopetrosis: The radioclinical features with literature update

Background: Osteopetrosis is a rare hereditary metabolic bone disorder characterized by generalized skeletal sclerosis caused by a defect in bone resorption and remodelling. Infantile autosomal recessive osteopetrosis is one of three subtypes of osteopetrosis and the most severe form. The correct and early diagnosis of infantile osteopetrosis is important for management of complications and for future genetic counselling. Diagnosis is largely based on clinical and radiographic evaluation, confirmed by gene testing where applicable. Methods: Therefore, in this case study the classical clinical and radiological signs of a boy with infantile osteopetrosis will be presented with a comprehensive literature update. The differentiating signs from other causes of hereditary osteosclerosing dysplasias are discussed. Results: This case study and review of available literature show that there tends to be a highly unique clinical and skeletal radiographic pattern of affection in infantile osteopetrosis. Conclusion: Although tremendous advances have been made in the elucidation of the genetic defect of osteopetrosis over the past years, the role of accurate clinical and radiological assessment remains an important contributor to the diagnosis of infantile osteopetrosis

Pseudoachondroplasia in a child: The role of anthropometric measurements and skeletal imaging in differential diagnosis

Pseudoachondroplasia is a rare osteochondrodysplasia characterized by disproportionate short stature and limb deformity. Diagnostic accuracy is based on a detailed evaluation of the radioclinical features. We report a boy with pseudoachondroplasia. We aim to underscore why is accurate delineation of the pattern of radioclinical skeletal abnormalities in pseudoachondroplasia a weighty part of diagnosis. Furthermore, we aim to highlight the main clinical and skeletal imaging features of skeletal dysplasias that overlap with pseudoachondroplasia using clinical cases evaluated in our institution. The findings affirm that anthropometric measurements and skeletal radiography are important contributors to the differential diagnosis and classification of disproportionate growth

Design and Analysis of New Version of Cryptographic Hash Function Based on Improved Chaotic Maps With Induced DNA Sequences

One of the first and most used hashing algorithms in blockchains is SHA-256 so the main aim of this paper is how to increase the security level of the blockchain based on the increasing hashing algorithm security. This paper proposes to present a modified SHA-256 like hash algorithm by exploring the design principles of the two hash schemes (SHA-256 and RIPEMD-160). To retrieve the increased security in the proposed algorithm, we modify the SHA-256 after the public key generation. The proposed modification is based on four different chosen types of chaotic maps and DNA sequences which eventually complicate the association between the original message and hash digest i.e., maximizing the security level, and minimizing its vulnerabilities. The proposed hash function efficiency is practically assessed, analyzed, and compared with the well-known SHA-256 with respect to the main properties of the confusion, diffusion and distribution. The security performance is also analyzed using the analysis of collision, which reveals that the new constructed hash function improves SHA-256 with respect to the security and robustness. From the experimental analyses results, the proposed modified hash scheme found to exhibit the better security performance than many state-of-the art existing hash function schemes