[Complications related to the existence of a lunotriquetral synostosis]

The authors report the observation of a patient, in whom coexisted a hypersolicitation of the wrists, a congenital lunatotriquetral fusion, a stress fracture of the hook of the hamate and a VISI, giving evidence of a medial carpal instability. They analyse the factors, which allow to understand the relations between these different elements. They caution against arthrodesis, advocated in the treatment of VISI.

Management of antebrachial deformity and shortening secondary to a synostosis in a dog

A nine-week-old labrador was presented with a deformed left forelimb causing obvious lameness. Radiographs suggested that the dog had suffered a fracture involving the radius and ulna which had healed resulting in a synostosis. There was a concurrent radial physeal injury. The dog was treated initially by osteotomy of the radius and ulna stabilised using a static external skeletal fixator. At a subsequent surgery lengthening of the limb was achieved by using an Ilizarov apparatus. Worsening carpal hyperflexion was managed by bandaging in forced extension. A successful outcome was achieved with a final result of a 24 per cent discrepancy in length between the two radii at 17 months of age. An increase in length of the ipsilateral humerus was seen in association with the shortened forelimb.

[Hypoglossia-hypodactylia syndrome: apropos of a case with maxillo-mandibular synostosis, glossopalatine ankylosis and cleft palate]

BACKGROUND

The hypoglossia-hypodactylia syndrome, a combination of limb hypogenesis and micrognathia is exceptionally associated with glossopalatine ankylosis and cleft palate.

CASE REPORT

A twin girl from monochorionic pregnancy had hypoglossia and micrognathia with anterior maxillo-mandibular fusion, glossopalatine ankylosis and cleft palate. Her left foot was amputated distal to the talus and calcaneous; her right foot had only one phallange. The second phallange of the second finger was hypoplastic on her right hand. There was no abnormality on left hand. Her sister was unaffected. The maxillo-mandibular fusion was divided on second day. The infant was able to suckle on the tenth day. Episodes of airway obstruction occurred on cardiorespiratory recording and the patient was further monitored at home.

CONCLUSION

This case suggests that the hemodynamic disorders due to multiple vascular connections from monochorionic pregnancies may have induced ischemic lesions of hypoglossia-hypodactylia. Other malformations and signs of brain stem dysfunction should be detected.

Radio-ulnar synostosis, short stature, microcephaly, scoliosis, and mental retardation

We report on a 9-year-old boy with radio-ulnar synostosis, short stature, microcephaly, scoliosis, and mental retardation. We propose that he has a new syndrome.

[Complete synostosis of the cervical spine at a young age. A thus far unpublished disease]

A case of complete synostosis of the cervical spine in a 12-year-old girl is described. Differential diagnosis included dysontogenetic forms of synostosis, Klippel-Feil syndrome, rheumatic synostosis and synostosis of other inflammatory origin. This severe case, the first of its type to be described, appeared to be due to tuberculosis of the cervical spine.

The Antley-Bixler syndrome: report of two familial cases with severe renal and anal anomalies

The Antley-Bixler syndrome is characterized by premature closure of coronal and lambdoidal sutures, proptosis, depression of the nasal bridge, brachycephaly, radio-humeral synostosis and bowing of ulnae and femora associated with fractures. Most cases have been reported after birth with only one case diagnosed prenatally after recurrence of this autosomal recessive syndrome. The two present cases are of interest because of prenatal diagnosis of renal agenesis in the first case and early detection of clinical signs during the second pregnancy. Beside the unusual severity of the renal abnormalities, both cases had an imperforate anus in addition to the more common genital abnormalities.

CONCLUSION

Renal agenesis and imperforate anus may occur in the Antley-Bixler syndrome.

[Multiple synostosis]

A sporadic and a familial case with multiple synostosis (symphalangism syndrome) are described with the demonstration of other symptoms (e.g. fusion of middle ear ossicles with conductive deafness). The differential-diagnosis of about 15 syndromes including symphalangism is discussed.

Contracted valgus flat foot caused by tarsal synostosis in the adolescent

Contracted valgus flat foot in the adolescent is frequently caused by tarsal synostosis or synchondrosis which are often not revealed in common radiographic views, and which may instead by clearly shown by CT scan. These synostoses are prevalently symptomatic during adolescence, when by ossifying they block the subtalar joint in valgus; they are less symptomatic between 20 and 40 years of age. Pain returns during the fifth decade due to the occurrence of secondary arthrosis of the nearby joints.

Fibular stress fracture associated with distal tibiofibular synostosis in an athlete. A case report and literature review

A 19-year-old collegiate football player with progressive ankle syndesmosis ossification developed acute localized fibular tenderness. Roentgenograms demonstrated a fibular stress fracture proximal to the superior extent of the ossific mass. Surgical resection of the mass resulted in uneventful fibular healing, with resolution of acute and chronic symptoms.

Restricted opening of the mouth with an extra-articular cause in children

Restricted opening of the mouth with an extra-articular cause (ROMEC) can have very different aetiologies. A series of 6 children, who have been operated on under 4 different diagnoses, are presented. Excluded are common problems such as recent trauma and posttraumatic scarring, craniomandibular dysfunction or elongated coronoid process, and also tumours. Problems of establishing the diagnosis, surgical treatment, postoperative physiotherapy and timing are discussed. It is shown that none of the cases is a perfect result, some outcomes are even very disappointing. It is therefore concluded that absolute trismus should be treated independently of age. The result expected will be mediocre. For final correction it is suggested that the operator should wait preferably until the second growth spurt has passed. The same goes for children presenting primarily with a mouth opening greater than 20 mm.

Symptomatic talocalcaneal coalition. Its clinical significance and treatment

The clinical significance of symptomatic talocalcaneal coalition was described subjectively, objectively, and identified roentgenographically after examining 67 feet of 42 patients between 1977 and 1987. Computed tomographic examinations, conducted on 29 of 42 patients, were useful in recognizing the extent of coalition, the condition of union, and the postoperative results. Tarsal tunnel syndrome was present in 23 feet with the coalition. Thirty-one feet (24 patients) were treated conservatively and 36 feet (29 patients) surgically. Of the surgically treated feet, the coalition was excised in 33 and talocalcaneal fusion was performed in three. Follow-up examinations were performed at an average of 5.3 years (range, 2.25-11.2 years). In the excision group, the results were excellent in 24 feet, good in seven, and fair in two. The results were good in three feet treated by arthrodesis.

Radio-ulnar synostosis in Williams syndrome. A frequently associated anomaly

Limitation of supination and pronation of the forearm has been occasionally described in individuals with Williams syndrome. It was found in 26% of 23 subjects examined, and was associated with a spectrum of severity of radio-ulnar synostosis on radiography. The occurrence of this functional motor impairment in a substantial subset of persons with Williams syndrome is relevant, because its evaluation is important in habilitation planning.

Congenital talonavicular synostosis. A review of the literature and a case report

The diagnosis of a congenital talonavicular coalition is one that often may be little more than an incidental radiographic finding. However, the acute onset of vague midfoot symptomatology secondary to a minor traumatic event may reveal this rarely reported condition on further clinical examination. The authors present a description of the characteristic historical and clinical features of talonavicular coalitions, current diagnostic and treatment modalities available, and a case presentation of an acute painful talonavicular synostosis in an adolescent male athlete.

Triquetral-lunate arthritis secondary to synostosis

Until recently the problem of painful, symptomatic arthritis of the wrist secondary to congenitally incomplete separation of carpal bones has been infrequently recognized. Five patients with either excessive stress loading or trauma had eight symptomatic wrists with congenitally incomplete separation of the triquetral-lunate joint. Three of these patients had bilateral symptoms. Six of the wrists had been treated by a limited wrist arthrodesis of the triquetral-lunate joint resulting in asymptomatic wrists and improved range of motion. It appears that patients with this congenital condition poorly tolerate stress loading or trauma secondary to deficient intra-articular cartilage formation resulting in a clinical and anatomic state similar to degenerative arthritis. We suggest a limited wrist arthrodesis as definitive treatment for symptomatic congenitally incomplete separation of the triquetral-lunate joint, with possible application in incomplete separation of the other intercarpal joints.

Symphalangism in Hawaii: a study of three distinct ethnic pedigrees

Symphalangism was introduced into Hawaii by a Cherokee Indian in the late 1800s. The resultant pedigree, along with two other racially distinct pedigrees, confirms that the condition is an autosomal dominant genetic trait. Associated conditions include carpal and tarsal coalitions, cervical fusions, brachydactylism, symphalangism of the toes, and hearing loss. Surgical intervention in the hands is seldom, if ever, indicated but correction of the associated hearing loss is rewarding.

Sagittal synostosis--its clinical significance and the results of three different methods of craniectomy

From 1973 to 1986, 50 infants with sagittal synostosis have been operated by three different methods of craniectomy (linear craniectomy and extended craniectomies, as proposed by Schut and Epstein et al.). Preoperatively, the mean cephalic index was 67 +/- 4, 35.5% had clinical findings as cerebral palsy, psychomotor retardation and/or neurological signs, and intraoperatively the epidural pressure was more than 200 mm H2O in 60% (recorded in the last 20 patients). The mean follow-up time was 4.7 (1-10.6) years. Postoperatively, only 14.5% had minor clinical signs, which were mostly not in relation to the former scaphocephaly. Half of the patients with increased ICP had clinical signs preoperatively, and none of the 20 patients had distinct findings postoperatively. Out of the 20 children operated on by linear craniectomy or by Schut's method up to 1980, two-thirds had no school problems and one-third some school problems; one-third had occasionally headaches and one-quarter ametropia. Concerning the aesthetic results, Epstein's method and, somewhat less Schut's method, were superior to linear craniectomy, as verified by craniometry and by the tracings of the outlines of the neurocranium 0.4-0.7 and 1.6-2.0 years postoperatively: mean cephalic indices 73 +/- 5 (normal in one-fourth), 74 +/- 7 (normal in half) and 79 +/- 4 (normal in nearly all patients). Epstein's method is superior to the other two methods because it renders it possible to increase the breadth the greatest during the period of greatest postnatal brain growth. In addition to the effect on the neurocranium, the extended craniectomies add to normalization of the base of the skull (in contrast to the natural history of scaphocephaly). In the long run, the results obtained remain the same. The disadvantage of residual skull defects (approximately 11% of the patients with extended craniectomies) can be avoided by performing surgery prior to 4-6 months of age or by preserving the removed bone in a deep-freeze for a limited time.

[Meningocele in the cervical segment of the spine associated with vertebral fusion]

The authors describe a patient aged 22 years in whom a developmental anomaly was found with fusion of the vertebral bodies C4 through C6, posterior spina bifida from C5 through Th1 and meningocele at the level C4 through C7. The meningocele was removed surgically. The case illustrates an integral connection between this set of anomalies and the malformations from the group of dysraphism.

Tarsal coalitions

Tarsal coalition is a relatively rare anomaly with varying degrees of fusion between two or more tarsal bones. Symptoms, if present, usually begin early in life and include: flatfoot, decreased motion, vague foot pain, and peroneal spasm. Some persons with the anomaly never develop symptoms, so treatment should not be started until symptoms are present. If treatment becomes necessary, conservative treatment should be attempted first. If that fails, surgical intervention may be necessary.

[Causes of recurrence of congenital clubfoot in children and indications for surgical treatment]

Unsatisfactory results of the conservative treatment of club foot deformity in 220 patients (346 feet) were analyzed. Data of roentgenograms in 86 patients enabled the authors to make a conclusion that an early cause of recurrent club foot is the delayed formation of nuclei of ossification of the navicular and I sphenoid bones, the later cause of the recurrent deformity is early synostosis of the epiphysis of the metatarsal bone. The importance of dispensary observation ad prophylactic measures after the treatment of congenital club foot is emphasized.

[Bilateral lunato-triquetral synostosis with bilateral fracture of the scaphoid bone]

The authors have treated a case of bilateral fracture of the scaphoid bone in a young man who had complete and bilateral lunato-triquetral synostosis, without any other associated congenital condition. Consolidation was obtained by orthopedic treatment on one side, but a Matti-Russe operation was necessary on the other. The authors emphasize but then rule out the hypothesis of a congenital bipartite scaphoid associated with the synostosis. A review of the literature on lunato-triquetral synostoses sums up the main points. The condition is rare in whites and occurs more frequently in blacks. It is sometimes associated with other congenital conditions. Four anatomic and radiologic types have been described. The pathogenic hypotheses, based on embryology, are summarized.

[Dysontogenetic blockbuilding of the vertebrae at the lumbo dorsal junction]

It is reported in two cases of synostosis of the vertebral which is related in the Medical literature as "Dysontogenetic blockbuilding of the Corpus Vertebrae". This condition could be seen in a 13 year old boy in the area of Th 9 to Th 12 and in a 13 year old girl from Th 11 to L1. The clinical and radiological findings of these two cases will be described and discussed. An attribution of these cases to the "Dysontogenetic blockbuilding" groups was based on a disturbance of the vertebral forming. A causal therapy is not possible.