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Taniwaki H, Shintani K, Aono M. Previously unreported X-ray findings associated with distal toe pain in children. J Pediatr Orthop B 2024; 33:53-57. [PMID: 36756944 DOI: 10.1097/bpb.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
While children undergo skeletal maturation, it is difficult to distinguish between normal variants and abnormalities of the epiphysis and acrophysis on radiological images. Abnormalities in the epiphysis and acrophysis of the toe phalanx have not been reported yet. Here, we describe a series of abnormalities in the epiphysis and acrophysis of the fourth and fifth toe phalanges, including an investigation of their pathogenesis. We evaluated patients suspected of having bone tumors at a local orthopedic clinic because of abnormal findings of the toe phalanx between the distal and middle phalanx on plain radiographs. The site of the lesion, duration of pain until the hospital visit, history of trauma and sports, treatment, and clinical course were investigated. A total of seven patients (five boys and two girls) with a mean age of 10 years (range 9-16) were included. In all cases, a circular erosive radiolucent image was present between the distal and middle phalanx. In two cases, the fourth toe was affected, and in five cases, the fifth toe was affected. Six patients showed improvements with conservative treatment using shoe insoles. In one case, surgical treatment was performed for persistent pain. Histological examination of the fibrous tissue collected from the circular erosive radiolucent area revealed normal bone and slightly degenerated hyaline cartilage. This is the first report on the abnormalities of the epiphysis and acrophysis of the toe phalanx, which is termed as Shintaniwakino disease. A better understanding of this disease may aid in the avoidance of unnecessary treatment.
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Affiliation(s)
| | - Kosuke Shintani
- Department of Orthopaedic Surgery, Osaka City Juso Hospital
- Department of Pediatric Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Masanari Aono
- Department of Orthopaedic Surgery, Osaka City General Hospital
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Sharma S, Dhillon MS, Singh G, Das A. Fibular Strut Arthrodesis for Salvage of Campanacci Grade III Giant Cell Tumor of the Hallucal Proximal Phalanx: A Case Report. J Foot Ankle Surg 2021; 60:861-865. [PMID: 33757685 DOI: 10.1053/j.jfas.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
Involvement of toe phalanges by giant cell tumor (GCT) is extremely rare; tumors in these locations tend to be aggressive. Whereas aggressive GCTs of the distal phalanx may be managed successfully by en-bloc resection without reconstruction or amputation, management of these lesions, when they involve the proximal phalanx, can be challenging. We present a Campannaci grade III GCT of the hallucal proximal phalanx in a 14-year old girl that had breached into the dorsal soft tissues and the metatarso-phalangeal joint. Wide local resection of the proximal phalanx along with reconstruction arthrodesis with an autologous, non-vascularized fibular strut graft was performed. There was no recurrence at 3 years of follow-up. The patient had an excellent functional outcome. To the best of our knowledge, this is the first case reporting the outcomes of fibular strut arthrodesis for salvage of GCT of the hallucal proximal phalanx.
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Affiliation(s)
- Siddhartha Sharma
- Associate Professor, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Mandeep S Dhillon
- Professor and Head, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaganpreet Singh
- Assistant Professor, Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, India
| | - Ashim Das
- Professor, Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Li DT, Linderman GC, Cui JJ, DeVries S, Nicholson AD, Li E, Petit L, Kahan JB, Talty R, Kluger Y, Cooperman DR, Smith BG. The Proximal Humeral Ossification System Improves Assessment of Maturity in Patients with Scoliosis. J Bone Joint Surg Am 2019; 101:1868-1874. [PMID: 31626012 PMCID: PMC7515481 DOI: 10.2106/jbjs.19.00296] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We recently developed a classification system to assess skeletal maturity by scoring proximal humeral ossification in a similar way to the canonical Risser sign. The purpose of the present study was to determine whether our system can be used to reliably assess radiographs of the spine for modern patients with idiopathic scoliosis, whether it can be used in combination with the Sanders hand system, and whether the consideration of patient factors such as age, sex, and standing height improves the accuracy of predictions. METHODS We retrospectively reviewed 414 randomized radiographs from 216 modern patients with scoliosis and measured reliability with use of the intraclass correlation coefficient (ICC). We then analyzed 606 proximal humeral radiographs for 70 children from a historical collection to determine the value of integrating multiple classification systems. The age of peak height velocity (PHV) was predicted with use of linear regression models, and performance was evaluated with use of tenfold cross-validation. RESULTS The proximal humeral ossification system demonstrated excellent reliability in modern patients with scoliosis, with an ICC of 0.97 and 0.92 for intraobserver and interobserver comparisons, respectively. The use of our system in combination with the Sanders hand system yielded 7 categories prior to PHV and demonstrated better results compared with either system alone. Linear regression algorithms showed that integration of the proximal part of the humerus, patient factors, and other classification systems outperformed models based on canonical Risser and triradiate-closure methods. CONCLUSIONS Humeral head ossification can be reliably assessed in modern patients with scoliosis. Furthermore, the system described here can be used in combination with other parameters such as the Sanders hand system, age, sex, and height to predict PHV and percent growth remaining with high accuracy. CLINICAL RELEVANCE The proximal humeral ossification system can improve the prediction of PHV in patients with scoliosis on the basis of a standard spine radiograph without a hand radiograph for the determination of bone age. This increased accuracy for predicting maturity will allow physicians to better assess patient maturity relative to PHV and therefore can help to guide treatment decision-making without increasing radiation exposure, time, or cost. The present study demonstrates that assessment of the proximal humeral physis is a viable and valuable aid in the determination of skeletal maturity as obtained from radiographs of the spine that happen to include the shoulder in adolescent patients with idiopathic scoliosis.
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Affiliation(s)
- Don T. Li
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - George C. Linderman
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Jonathan J. Cui
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Stephen DeVries
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Allen D. Nicholson
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Eric Li
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Logan Petit
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Joseph B. Kahan
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Ronan Talty
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Yuval Kluger
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Daniel R. Cooperman
- Departments of Orthopaedics and Rehabilitation (D.T.L., G.C.L., J.J.C., S.D., A.D.N., E.L., L.P., J.B.K., R.T., and D.R.C.), Cell Biology (D.T.L.), Applied Mathematics (G.C.L.), and Pathology (Y.K.), Yale School of Medicine, New Haven, Connecticut
| | - Brian G. Smith
- Division of Orthopaedics and Scoliosis, Texas Children’s Hospital, Houston, Texas
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