Surgical Management of Juvenile Idiopathic Arthritis Related Dentofacial Deformities

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease of childhood and frequently affects the temporomandibular joints (TMJ). JIA TMJ management requires a team approach. Initially, TMJ JIA involvement is managed with systemic therapy or intra-articular medications to treat symptoms and limit the growth deformity, however may later require surgical intervention. This case series describes 4 patients with different presentations and treatments of juvenile idiopathic arthritis affecting the temporomandibular joints to illustrate a proposed treatment algorithm. This algorithm is not designed to be an absolute treatment regimen but a framework to help clarify the presenting problems and interventions that may be considered to treat JIA associated temporomandibular dysfunction and dentofacial deformity. This case series represents the variety of JIA temporomandibular joint disease and offers a graduated appropriate treatment algorithm.

Brodie's Abscesses Can Stimulate the Growth Plate in Children

Introduction: We present a series of children with lower limb Brodie's abscesses (subacute osteomyelitis) with subsequent deformities.Method: A retrospective examination of the paediatric bone and joint infection database from 2014-2017 was performed. All children have MRI scans and blood tests including full blood count, ESR and CRP. MRI identified collections were drained surgically.Results: There were 68 children with bone and joint infections, and 6 had a Brodie's abscess. 4 Brodie's abscesses were adjacent to a growth plate, all these had resultant growth deformities. Some deformities develop up to 3 years after initial presentation.Discussion: We recommend long-term vigilance for growth deformity after a Brodie's abscess. In particular we demonstrate that infection can result in stimulation of the physis, as opposed to growth retardation as generally accepted.

Trace fossils and tropical karst

Two crinoid pluricolumnals from Permian rocks of Timor show similar patterns of external pitting. Platycrinitid sp. preserves circular, parabolic pits that do not cross-cut between columnals, some have raised rims and at least one columnal shows a growth deformity. These pits are interpreted as the trace fossil Oichnus paraboloides Bromley. Crinoid sp. indet. has particularly dense pits cross-cutting columnals on one side of the pluricolumnal only and extending onto the contiguous limestone; it is a Holocene microkarstic solution feature. Care must be taken to separate true bioerosive trace fossils from modern microkarstic features in limestones in the tropics.

Carpal derangement and associated carpal valgus in a dog

SummaryThis case report describes derangement of the numbered carpal bones resulting in a valgal growth deformity in the right carpus of a seven-month-old dog. Radiographic assessment of the right carpus revealed abnormalities in the size and shape of the numbered carpal bones and carpal valgus. Surgical correction of the growth deformity was planned by partial carpal arthrodesis; however medial collateral laxity associated with the carpal valgus necessitated a pancarpal arthrodesis to achieve correct limb alignment.