Staged correction of varus knee and lateral thrust in an achondroplastic (ACH) juvenile patient who underwent limb lengthening with IM nails: tips for proper timing and prioritisation of procedures

2021 ◽  
Vol 14 (9) ◽  
pp. e242033
Author(s):  
Androniki Drakou ◽  
Lukia Koutsogewrgopoulou ◽  
Georgios Boutzios ◽  
Markos Psifis
Keyword(s):  
Lower Limb ◽  
Distal Femur ◽  
Lateral Collateral Ligament ◽  
Limb Lengthening ◽  
Varus Deformity ◽  
Lateral Thrust ◽  
Valgus Osteotomy ◽  
Tibial Lengthening ◽  
Ilizarov Frame ◽  
The Right

We present the case of a fifteen-year-old achondroplastic (ACH) woman who requested to have her femurs lengthened by intramedullary nails. She had undergone bilateral tibial lengthening at the age of eleven and presented with a varus deformity of the right lower limb, lateral thrust of the right knee and valgus deformity of the left lower limb. We performed deformity analyses based on mechanical axis measurements, and we came with a staged surgical plan. In ACH adolescences, correction of bony deformity needs to encounter continuous fibula growth dynamics. Lateral knee thrust was corrected by gradual distal translation of the fibula head via an Ilizarov frame and the amount of translation we decided clinically. Tibial lengthening and valgus osteotomy of the distal femur accentuate lateral collateral ligament (LCL) complex laxity. In patients with ACH, tibial lengthening and valgus osteotomy of the distal femur—if needed—should precede LCL complex tightening, and femoral lengthening should follow.

scholarly journals Lower limb lengthening over an intramedullary nail: a long-term follow-up study of 28 cases

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Farsetti ◽  
Fernando De Maio ◽  
Vito Potenza ◽  
Kristian Efremov ◽  
Martina Marsiolo ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Lower Limb ◽  
Average Length ◽  
Limb Lengthening ◽  
Limb Length ◽  
Tibial Lengthening ◽  
The Mean

Abstract Background Limb lengthening using an external fixator requires a long period of external fixation and may be associated with several complications such as axial deformity, fracture of the regenerated bone, and joint stiffness. With the goal of reducing the time of external fixation as well as some of these complications, we performed femoral or tibial lengthening over an intramedullary nail, according to Paley’s technique, in 28 patients, followed up after a mean period of 8 years. Materials and methods Twenty-eight patients treated for lower limb discrepancy by limb lengthening over an intramedullary nail were reviewed from 5 to 11 years after healing of regenerated bone. There were 20 femurs and 8 tibiae, with average age at surgery of 14.2 years and average length inequality of 6.1 cm for femurs and 5.3 cm for tibiae. Results The mean lengthening was 5.8 cm for femurs and 4.8 cm for tibiae. The mean period of radiographic consolidation of the regenerated bone was 6 months for femoral lengthening and 4.5 months for tibial lengthening. At follow-up, we observed 8 excellent results, 15 good results, 4 fair results, and 1 poor result, based on Paley’s evaluation criteria. The main complications were one deep infection, one nonunion of the distracted segment, one breakage of the distal fiche of the external fixator, and one breakage of both distal locking screws of the intramedullary nail. Discussion We believe that limb lengthening over an intramedullary nail still represents a good method to treat limb length discrepancy because it reduces the time of external fixation, prevents axial deformities and fractures of regenerated bone, and allows early rehabilitation. The new intramedullary lengthening nails, which theoretically are the ideal device for treating limb length inequality, are still very expensive and need longer follow-up for definitive evaluation. Level of evidence 4.

Sacral plexus disorder caused by a wooden toothpick in the rectum

2021 ◽  
Vol 14 (1) ◽  
pp. e238690
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Lower Limb ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Sacral Plexus ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Preoperative Ct ◽  
History Of ◽  
History Of Pain ◽  
The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

scholarly journals Esthetic and Functional Improvement of Asymmetric Lower Limb Overgrowth in a Proteus Syndrome Patient: a Combined Surgical Technique

2021 ◽  
Author(s):  
Francesca Riccardi ◽  
Simone Catapano ◽  
Giuseppe Cottone ◽  
Dino Zilio ◽  
Luca Vaienti
Keyword(s):  
Adipose Tissue ◽  
Lower Limb ◽  
Vascular Malformations ◽  
Functional Improvement ◽  
Proteus Syndrome ◽  
Phosphatase And Tensin Homolog ◽  
Tensin Homolog ◽  
Genetic Mosaicism ◽  
Phosphoinositide 3 Kinase ◽  
The Right

AbstractProteus syndrome is a rare, sporadic, congenital syndrome that causes asymmetric and disproportionate overgrowth of limbs, connective tissue nevi, epidermal nevi, alteration of adipose tissue, and vascular malformations. Genetic mosaicism, such as activating mutations involving protein kinase AKT1, phosphoinositide 3 kinase (PI3-K), and phosphatase and tensin homolog (PTEN), may be important causes of Proteus syndrome. However, many patients have no evidence of mutations in these genes. Currently, the diagnosis is clinical and based on phenotypic features. This article reports a case of Proteus syndrome in a 14-year-old female patient who presented with linear epidermal nevi, viscera anomalies, and adipose tissue dysregulation. She showed an asymmetric progressive overgrowth of the right lower limb after birth bringing relevant functional and esthetic consequences. Therefore, she asked a plastic surgery consultation and a surgical treatment with a combined technique was planned. With our approach, we were able to reduce leg diameter and improve joint mobility reliably and safely with satisfying esthetic results.

Accessory museulus soleus

1926 ◽  
Vol 22 (5-6) ◽  
pp. 511-513
Author(s):  
V. N. Ternovsky ◽  
M. Sadykova
Keyword(s):  
Lower Limb ◽  
Lower Leg ◽  
Flexor Hallucis Longus ◽  
Posterior Surface ◽  
Flexor Digitorum Longus ◽  
Accessory Muscle ◽  
Peroneus Brevis ◽  
The Right ◽  
Flexor Digitorum

Dissecting the muscles of the right lower limb of an unknown corpse, we found an accessory muscle on the posterior surface of the lower leg. This muscle (see Fig.) Was bordered behind in. soleus and with the tendon m. plantaris, in front - with in. flexor hallucis longus, medially - c m. flexor digitorum longus and laterally - c m. peroneus brevis.

Stren. A case of melorheostosis. (Acta Chirurgica Scandinavica Vol. LXXVIII, Fasc. I-III, S. 94-102)

1937 ◽  
Vol 33 (1) ◽  
pp. 111-111
Author(s):  
V. S. Mayat
Keyword(s):  
Lower Limb ◽  
Lower Leg ◽  
The Right ◽  
Entire Limb

The author reports a case of melorheostosis (osteosclerotic process) in the right lower limb in a 13-year-old girl. The case of the author. fourteenth in literature. With this disease, a significant shortening of the entire limb is found, and 3/4 of the shortening refers to the lower leg, the damaged part of which is more affected.

scholarly journals Surgical Treatment for Malunion of the Lateral Humeral Epicondyle with Posterior Subluxation of the Radial Head: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Koichi Yano ◽  
Yasunori Kaneshiro ◽  
Hideki Sakanaka
Keyword(s):  
Lateral Collateral Ligament ◽  
High Energy ◽  
Limited Range ◽  
Forearm Rotation ◽  
Collateral Ligament ◽  
Lateral Epicondyle ◽  
Limited Range Of Motion ◽  
Contracture Release ◽  
Normal Congruence ◽  
The Right

A 24-year-old right-handed man suffered right olecranon and lateral epicondylar fracture from high energy trauma. Fixation of olecranon was performed by a previous doctor. Three months after operation, he presented with limited range of motion (ROM) of the right elbow caused by malunion of the lateral epicondylar fracture and subluxation of the radiohumeral joint. Preoperative ROM of the right elbow was flexion 110° and extension −75°. Forearm rotation was pronation 85° and supination 65°. Fragment excision of the lateral epicondyle, which was 27 mm in length, and lateral collateral ligament repair using anchors were performed. Fourteen months postoperatively, contracture release of the elbow was performed. Twenty-four months postoperatively, radiograph of the elbow showed normal congruence without osteoarthritic changes and the ROM of the right elbow was flexion 120° and extension −35°. Forearm rotation was pronation 90° and supination 70°. In the surgical setting, in case of the size of the lateral epicondylar fragment is relatively large, the fragment should be fixed or lateral collateral ligament should be repaired when the instability of the elbow is found.

Psychologic, Vascular, and Physiologic Aspects of Lower Limb Lengthening in Achondroplastics

1990 ◽  
Vol &NA; (250) ◽  
pp. 138???142 ◽  
Author(s):  
FRANCO LAVINI ◽  
LODOVICO RENZI-BRIVIO ◽  
G. DE BASTIANI
Keyword(s):  
Lower Limb ◽  
Limb Lengthening

Lower-Limb Speed and Foot Preference in Children

1995 ◽  
Vol 81 (3_suppl) ◽  
pp. 1115-1118 ◽  
Author(s):  
Misaki Iteya ◽  
Carl Gabbard ◽  
Morihiko Okada
Keyword(s):  
Lower Limb ◽  
Environmental Influences ◽  
Statistical Evidence ◽  
Performance Characteristics ◽  
Gross Motor ◽  
Foot Tapping ◽  
And Performance ◽  
The Right ◽  
A Performance

Foot preference and performance characteristics of gross-motor lower-limb speed of tapping were examined in 606 4- to 6-yr.-olds. Analysis indicated no effect for gender; however, speed of foot tapping increased significantly across the three ages, suggesting an association with selected developmental (neuromuscular) processes. Contrary to earlier reports on handedness, there was no statistical evidence that mixed- or left-footers were at a performance disadvantage compared to right-footers. All groups performed best with the right foot, limb differentiation (right versus left) being significant for the right- and mixed-footed groups. Speculation about maturational and environmental influences is given.

Effect of unweighting on skeletal muscle use during exercise

1995 ◽  
Vol 79 (1) ◽  
pp. 168-175 ◽  
Author(s):  
L. L. Ploutz-Snyder ◽  
P. A. Tesch ◽  
D. J. Crittenden ◽  
G. A. Dudley
Keyword(s):  
Lower Limb ◽  
Weight Bearing ◽  
Muscle Group ◽  
Mr Images ◽  
Cross Sectional ◽  
Quadriceps Femoris Muscle ◽  
Before And After ◽  
Exercise Induced ◽  
The Right ◽  
Femoris Muscle

Exercise-induced spin-spin relaxation time (T2) shifts in magnetic resonance (MR) images were used to test the hypothesis that more muscle would be used to perform a given submaximal task after 5 wk of unweighting. Before and after unilateral lower limb suspension (ULLS), 7 subjects performed 5 sets of 10 unilateral concentric actions with the quadriceps femoris muscle group (QF) at each of 4 loads: 25, 40, 55, and 70% of maximum. T2-weighted MR images of the thigh were collected at rest and after each relative load. ULLS elicited a 20% decrease in strength of the left unweighted QF and a 14% decrease in average cross-sectional area (CSA) with no changes in the right weight-bearing QF. Average CSA of the left or right QF showing exercise-induced T2 shift increased as a function of exercise intensity both before and after ULLS. On average, 12 +/- 1, 15 +/- 2, 18 +/- 2, and 22 +/- 1 cm2 of either QF showed elevated T2 for the 25, 40, 55, and 70% loads, respectively, before ULLS. Average CSA of the left but not the right QF, showing elevated T2 after ULLS, was increased to 16 +/- 2, 23 +/- 3, 31 +/- 7, and 39 +/- 5 cm2, respectively. The results indicated that unweighting increased exercise-induced T2 shift in MR images, presumably due to greater muscle mass involvement in exercise after than before unweighting, suggesting a change in motor control.

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