Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique

The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previous surgical correction were reviewed. Treatment included open releases. An Ilizarov frame was applied as an adjunct in seven patients (mean age of 7.8 years) with severe deformity where complete intraoperative correction was not achieved. Clinical and radiographic assessment was undertaken. The mean Laaveg–Ponseti score, for the 7 feet treated with the Ilizarov frame, was 85.1 after minimum 4 years follow-up. One recurrence of forefoot deformity required metatarsal osteotomies. Postoperative radiographic measurements revealed values that can be considered as normal. Complications included pin tract infections (12% of inserted wires). Flat-topped talus was observed in 3 feet. Deformity correction was possible when soft tissue procedures were combined with the use of Ilizarov technique, in order to support and gradually improve surgical correction

Managing periprosthetic fractures: perspectives on periprosthetic pelvic fractures

Periacetabular periprosthetic fractures are rare but potentially disastrous for the longevity of the adjacent implants, leading to multiple revision surgeries. It is of paramount importance to identify and treat intraoperative fractures, which will lead to satisfactory results. Postoperative fractures may be managed operatively or nonoperatively depending on the patient's pain and function, the fracture pattern, and the stability of the acetabular component

Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years

Background and purpose Tantalum rod implantation has recently been proposed for treatment of early stages of femoral head osteonecrosis. The purpose of our study was to report the early results of its use in pre- and post-collapse stages of the disease

Assessment of gene-by-sex interaction effect on bone mineral density

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Sexual dimorphism in various bone phenotypes, including bone mineral density (BMD), is widely observed; however, the extent to which genes explain these sex differences is unclear. To identify variants with different effects by sex, we examined gene-by-sex autosomal interactions genome-wide, and performed expression quantitative trait loci (eQTL) analysis and bioinformatics network analysis. We conducted an autosomal genome-wide meta-analysis of gene-by-sex interaction on lumbar spine (LS) and femoral neck (FN) BMD in 25,353 individuals from 8 cohorts. In a second stage, we followed up the 12 top single-nucleotide polymorphisms (SNPs; p < 1 × 10(-5) ) in an additional set of 24,763 individuals. Gene-by-sex interaction and sex-specific effects were examined in these 12 SNPs. We detected one novel genome-wide significant interaction associated with LS-BMD at the Chr3p26.1-p25.1 locus, near the GRM7 gene (male effect = 0.02 and p = 3.0 × 10(-5) ; female effect = -0.007 and p = 3.3 × 10(-2) ), and 11 suggestive loci associated with either FN- or LS-BMD in discovery cohorts. However, there was no evidence for genome-wide significant (p < 5 × 10(-8) ) gene-by-sex interaction in the joint analysis of discovery and replication cohorts. Despite the large collaborative effort, no genome-wide significant evidence for gene-by-sex interaction was found to influence BMD variation in this screen of autosomal markers. If they exist, gene-by-sex interactions for BMD probably have weak effects, accounting for less than 0.08% of the variation in these traits per implicated SNP. © 2012 American Society for Bone and Mineral Research.Medtronic NIH R01 AG18728 R01HL088119 R01AR046838 U01 HL084756 R01 AR43351 P01-HL45522 R01-MH-078111 R01-MH-083824 Nutrition and Obesity Research Center of Maryland P30DK072488 NIAMS/NIH F32AR059469 Instituto de Salud Carlos III-FIS (Spanish Health Ministry) PI 06/0034 PI08/0183 Canadian Institutes of Health Research (CIHR) NHLBI HHSN268201200036C N01-HC-85239 N01-HC-85079 N01-HC-85086 N01-HC-35129 N01 HC15103 N01 HC-55222 N01-HC-75150 N01-HC-45133 HL080295 HL087652 HL105756 NIA AG-023629 AG-15928 AG-20098 AG-027058 N01AG62101 N01AG62103 N01AG62106 1R01AG032098-01A1 National Center of Advancing Translational Technologies CTSI UL1TR000124 National Institute of Diabetes and Digestive and Kidney Diseases DK063491 EUROSPAN (European Special Populations Research Network) European Commission FP6 STRP grant 018947 LSHG-CT-2006-01947 Netherlands Organisation for Scientific Research Erasmus MC Centre for Medical Systems Biology (CMSB) Netherlands Brain Foundation (HersenStichting Nederland) US National Institute for Arthritis, Musculoskeletal and Skin Diseases National Institute on Aging R01 AR/AG41398 R01 AR050066 R21 AR056405 National Heart, Lung, and Blood Institute's Framingham Heart Study N01-HC-25195 Affymetrix, Inc. N02-HL-6-4278 Canadian Institutes of Health Research from Institute of Aging 165446 Institute of Genetics 179433 Institute of Musculoskeletal health 221765 Intramural Research Program of the NIH, National Institute on Aging National Institutes of Health HHSN268200782096C Hong Kong Research Grant Council HKU 768610M Bone Health Fund of HKU Foundation KC Wong Education Foundation Small Project Funding 201007176237 Matching Grant CRCG Grant Osteoporosis and Endocrine Research Fund Genomics Strategic Research Theme of The University of Hong Kong Netherlands Organisation of Scientific Research NWO Investments 175.010.2005.011 911-03-012 Research Institute for Diseases in the Elderly 014-93-015 Netherlands Genomics Initiative (NGI)/Netherlands Consortium for Healthy Aging (NCHA) 050-060-810 Erasmus Medical Center and Erasmus University, Rotterdam Netherlands Organization for the Health Research and Development (ZonMw) Research Institute for Diseases in the Elderly (RIDE) Ministry of Education, Culture and Science Ministry for Health, Welfare and Sports European Commission (DG XII) Municipality of Rotterdam German Bundesministerium fur Forschung und Technology 01 AK 803 A-H 01 IG 07015

Genetic Sharing with Cardiovascular Disease Risk Factors and Diabetes Reveals Novel Bone Mineral Density Loci.

Bone Mineral Density (BMD) is a highly heritable trait, but genome-wide association studies have identified few genetic risk factors. Epidemiological studies suggest associations between BMD and several traits and diseases, but the nature of the suggestive comorbidity is still unknown. We used a novel genetic pleiotropy-informed conditional False Discovery Rate (FDR) method to identify single nucleotide polymorphisms (SNPs) associated with BMD by leveraging cardiovascular disease (CVD) associated disorders and metabolic traits. By conditioning on SNPs associated with the CVD-related phenotypes, type 1 diabetes, type 2 diabetes, systolic blood pressure, diastolic blood pressure, high density lipoprotein, low density lipoprotein, triglycerides and waist hip ratio, we identified 65 novel independent BMD loci (26 with femoral neck BMD and 47 with lumbar spine BMD) at conditional FDR < 0.01. Many of the loci were confirmed in genetic expression studies. Genes validated at the mRNA levels were characteristic for the osteoblast/osteocyte lineage, Wnt signaling pathway and bone metabolism. The results provide new insight into genetic mechanisms of variability in BMD, and a better understanding of the genetic underpinnings of clinical comorbidity

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

SURGICAL TREATMENT OF CONGENITAL CLUBFOOT

Η ΣΥΓΓΕΝΗΣ ΡΑΙΒΟΙΠΠΟΠΟΔΙΑ ΕΙΝΑΙ ΣΥΧΝΗ ΑΝΩΜΑΛΙΑ ΤΟΥ ΑΚΡΟΥ ΠΟΔΙΟΥ, ΑΚΑΘΟΡΙΣΤΗΣ ΑΙΤΙΟΛΟΓΙΑΣ. ΟΙ ΠΑΡΑΜΟΡΦΩΣΕΙΣ ΑΦΟΡΟΥΝ ΤΑ ΤΡΙΑ ΕΠΙΠΕΔΑ: ΙΠΠΟΠΟΔΙΑ ΣΤΟ ΟΒΕΛΙΑΙΟ ΕΠΙΠΕΔΟ, ΥΠΤΙΑΣΜΟΣ ΣΤΟ ΜΕΤΩΠΙΑΙΟ ΚΑΙ ΠΡΟΣΑΓΩΓΗ ΠΡΟΣΘΙΟΥ ΠΟΔΙΟΥ ΣΤΟ ΟΡΙΖΟΝΤΙΟ ΕΠΙΠΕΔΟ. ΣΤΗΝ ΟΡΘΟΠΕΔΙΚΗ ΚΛΙΝΙΚΗ ΤΟΥ ΠΑΝΕΠΙΣΤΗΜΙΟΥ ΙΩΑΝΝΙΝΩΝ, ΑΝΤΙΜΕΤΩΠΙΣΤΗΚΑΝ ΧΕΙΡΟΥΡΓΙΚΑ ΚΑΤΑ ΤΟ ΧΡΟΝΙΚΟ ΔΙΑΣΤΗΜΑ 1982-1997, 33 ΑΣΘΕΝΕΙΣ ΜΕ ΡΙΠ. ΕΠΡΟΚΕΙΤΟ ΓΙΑ 25 ΑΓΟΡΙΑ ΚΑΙ 8 ΚΟΡΙΤΣΙΑ, ΗΛΙΚΙΑΣ 3 ΜΗΝΩΝ ΩΣ 20 ΕΤΩΝ. ΛΟΓΩ ΑΜΦΟΤΕΡΟΠΛΕΥΡΗΣ ΠΡΟΣΒΟΛΗΣ ΑΝΤΙΜΕΤΩΠΙΣΤΗΚΑΝ 42 ΠΟΔΙΑ ΣΤΑ 33 ΠΑΙΔΙΑ, ΜΕ 50 ΣΥΝΟΛΙΚΑ ΕΠΕΜΒΑΣΕΙΣ. ΑΝΑΛΟΓΑ ΜΕ ΤΗ ΣΚΛΗΡΟΤΗΤΑ ΤΩΝ ΠΑΡΑΜΟΡΦΩΣΕΩΝ ΤΑ ΠΟΔΙΑ ΤΑΞΙΝΟΜΗΘΗΚΑΝ ΠΡΟΕΓΧΕΙΡΙΤΙΚΑ ΣΕ 4 ΚΑΤΗΓΟΡΙΕΣ- ΤΑ ΠΟΔΙΑ ΠΟΥ ΑΝΤΙΜΕΤΩΠΙΣΤΗΚΑΝ ΧΕΙΡΟΥΡΓΙΚΑ ΑΝΗΚΑΝ ΣΤΗΝ ΠΛΕΙΟΨΗΦΙΑ ΤΟΥΣ ΣΤΙΣ ΚΑΤΗΓΟΡΙΕΣ ΙΙΙ ΚΑΙ IV (86%), ΕΝΩ ΑΚΤΙΝΟΛΟΓΙΚΑ Η ΑΣΤΡΑΓΑΛΟΠΤΕΡΝΙΚΗ ΓΩΝΙΑ ΕΤΕΙΝΕ ΣΤΙΣ 0^Ο. ΑΠΟ ΤΙΣ 50 ΧΕΙΡΟΥΡΓΙΚΕΣ ΕΠΕΜΒΑΣΕΙΣ, ΟΙ 32 ΗΤΑΝ ΕΠΕΜΒΑΣΕΙΣ ΠΡΩΤΟΓΕΝΟΥΣ ΑΝΤΙΜΕΤΩΠΙΣΗΣ ΤΗΣ ΡΙΠ, ΟΙ 15 ΗΤΑΝ ΕΠΕΜΒΑΣΕΙΣ ΑΝΤΙΜΕΤΩΠΙΣΗΣ ΥΠΟΛΕΙΜΜΑΤΙΚΩΝ ΜΟΡΦΩΝ ΚΑΙ 3 ΕΓΙΝΑΝ ΓΙΑ ΤΗΝ ΑΝΤΙΜΕΤΩΠΙΣΗ ΕΠΙΠΛΟΚΩΝ ΑΠΟ ΠΡΟΗΓΟΥΜΕΝΗ ΧΕΙΡΟΥΡΓΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΤΗΣ ΡΙΠ. ΣΥΝΟΛΙΚΑ ΠΡΑΓΜΑΤΟΠΟΙΗΘΗΚΑΝ 13 ΕΠΙΜΗΚΥΝΣΕΙΣ ΑΧΙΛΛΕΙΟΥ, 22 ΕΠΕΜΒΑΣΕΙΣ ΟΠΙΣΘΙΑΣ - ΕΣΩ ΣΥΝΔΕΣΜΟΛΥΣΗΣ-ΑΡΘΡΟΛΥΣΗΣ (ΤΕΧΝΙΚΗ TURCO), 7 ΕΠΕΜΒΑΣΕΙΣ ΡΑΧΙΑΙΑΣ ΣΥΝΔΕΣΜΟΛΥΣΗΣ -ΑΡΘΡΟΛΥΣΗΣ (HEYMAN-HERDON), 2 ΜΕΤΑΦΟΡΕΣ ΚΑΜΠΤΗΡΩΝ ΤΩΝ ΔΑΚΤΥΛΩΝ ΚΑΙ 6 ΟΣΤΙΚΕΣ.ΜΕΤΕΓΧΕΙΡΗΤΙΚΑ ΕΚΤΙΜΗΘΗΚΑΝ Η ΜΟΡΦΟΛΟΓΙΑ ΚΑΙ Η ΛΕΙΤΟΥΡΓΙΚΟΤΗΤΑ ΤΟΥ ΠΟΔΙΟΥ ΚΑΘΩΣ ΚΑΙ Η ΔΡΑΣΤΗΡΙΟΤΗΤΑ ΤΟΥ ΑΣΘΕΝΟΥΣ. Ο ΜΕΣΟΣ ΧΡΟΝΟΣ ΜΕΤΕΓΧΕΙΡΗΤΙΚΗΣ ΠΑΡΑΚΟΛΟΥΘΗΣΗΣ ΗΤΑΝ 2,7 ΧΡΟΝΙΑ ΚΑΙ ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΤΩΝ ΕΠΕΜΒΑΣΕΩΝ ΗΤΑΝ ΕΞΑΙΡΕΤΙΚΑ ΣΕ ΠΟΣΟΣΤΟ 32%, ΚΑΛΑ ΣΕ ΠΟΣΟΣΤΟ 52% ΚΑΙ ΠΤΩΧΑ ΣΕ 16%.CONGENITAL CLUBFOOT OR TALIPES EQUINOVARUS IS A COMMON CONGENITAL DEFORMITY, OF UNKNOWN ETIOLOGY. DEFORMITIES ARE PRESENT IN ALL THREE PLANES : EQUINUS OFTHE ANKLE IN THE SAGGITAL PLANE, ADDUCTION OF THE MIDFOOT AND FOREFOOT IN THE HORIZONTAL AND INVERSION OF THE FOOT IN THE CORONAL PLANE. IN THE DEPARTMENT OF THE ORTHOPAEDIC SURGERY OF UNIVERSITY OF IOANNINA, 33 PATIENTS WITH 42 AFFECTED FEET WERE SURGICALLY TREATED, WITH A TOTAL OF 50 PROCEDURES, BETWEEN 1982 AND 1997. ACCORDING TO THE REDUCIBILITY OF THE DEFORMITIES, FEET WERE CLASSIFIED PREOPERATIVELY IN 4 GROUPS. IN THE MAJORITY OF THE PATIENTS FEET WERECLASSIFIED TO GROUPS III AND IV (86%). RADIOLOGIC ASSESSMENT INCLUDED MEASUREMENT OF THE TALOCALACANEAL ANGLE IN ANTEROPOSTERIOR AND LATERAL X-RAYS - THE VALUES OF THE ANGULAR MEASUREMENTS WERE APPROXIMATELY 0^O. FIFTY PROCEDURES WERE PERFORMED FOR THE TREATMENT OF 42 CASES OF CLUBFOOT - 32 OF THESE WERE PERFORMED FOR PRIMARY TREATMENT OF TALIPES EQUINOVARUS, THE REMAINING WERE PERFORMED FOR RECURRENT CASES OR COMPLICATIONS (15 AND 3 PROCEDURES RESPECTIVELY), AFTER PREVIOUS SURGICAL TREATMENT (IN THE SAME OR OTHER HOSPITALS). THE MAJORITY OF THESE PROCEDURES (22) CONSISTED OF POSTEROMEDIAL RELEASE IN ONE STAGE (SLIGHT MODIFICATION OF THE TECHNIQUE DESCRIBED BY TURCO). THE REMAINING PROCEDURES CONSISTED OF ACHILLES LENGTHENING IN 13 FEET, TARSOMETATARSAL RELEASE (HEYMAN-HERDON PROCEDURE IN 7 CASES), TRANSFER OF THE LONG TOE FLEXORS IN 2 FEET AND 6 BONY PROCEDURES. FOLLOW-UP TIME RANGED FROM 6 MONTHS TO 11 YEARS (MEAN: 2,7 YEARS). (ABSTRA

Closed-space hand infections: diagnostic and treatment considerations

Despite modern diagnostic methods, surgical advances and antibiotics evolution, acute closed-space hand infections still remain a therapeutic challenge. The aim of this review is to present its special clinical features and the current therapeutic management based on the infection site, the type of the infecting pathogen and the host-type. Anatomic pathways facilitate the spread of the infection towards spots of decreased resistance. The accumulation of purulent material subsequently raises the pressure within the closed-space, leading to ischemia and necrosis. These infections are usually attributed to gram-positive cocci and clinicians should also consider the local spread of community-acquired methicillin resistant S. aureus and the host's comorbidities (immunosuppression, diabetes) before choosing the appropriate antibiotics. Surgical treatment including drainage and irrigation is imperative. The knowledge of anatomy, closed-space pathophysiology and current updates in microbiology and drainage/irrigation techniques are prerequisites for prompt diagnosis and optimal treatment of acute closed-space hand infections