No abstract

A case of unilateral genu recurvatum (GR) in a 15-year-old boy with a history of Guillain-Barre syndrome (GBS) and subsequent bilateral drop-foot is presented. Muscle imbalance of the lower limb and repetitive pressure from prolonged usage of an orthosis to deal with drop-foot may be the causative factors for early partial physeal arrest of his right proximal tibia. The result was a right GR and a shorter right lower limb. A below the tibial tuberosity anterior opening-wedge oblique proximal tibial osteotomy was performed. The deformity was gradually corrected using an Ilizarof circular frame. The center of rotation and angulation of the procedure was placed at the posterior tibial cortex. The procedure was completed uneventfully within four months. Excellent clinical and radiological improvement of the deformity was obtained.

A new method to quantify proximal femoral head-neck deformity in slipped capital femoral epiphysis (SCFE) is presented. In SCFE the femoral head slips posteriorly and inferiorly relative to the femoral neck. The distance of the femoral head center from the femoral neck axis (center-axis distance, CAD) represents the severity of the post-slip deformity. CAD is calculated on the anteroposterior and the frog-lateral pelvis views. It is shown that CAD is only a function of the femoral head-neck offset difference on both sides of the femoral neck. The percentage of CAD relative to the diameter of femoral neck is the femoral head-neck translation ratio (FHNTR) on the respective x-ray projection. Measurements on radiographs of 37 patients with history of unilateral SCFE were performed. The asymptomatic contralateral hips were used as controls. On the anteroposterior pelvis view, mean FHNTR was -12.2% and -4.3% for the affected and asymptomatic contralateral hips, respectively (paired t-test, p < .01), indicating inferior translation of the femoral head relative to the femoral neck. On the frog-lateral view, mean FHNTR was -21.1% and -6.5% for the affected and the contralateral hips, respectively (paired t-test, p < .01), indicating posterior translation of the femoral head relative to the femoral neck. There is a moderate inverse correlation between FHNTR on the froglateral pelvis view and Southwick's slip angle (Pearson correlation coefficient r = -0.679, p < .001). FHNTR on two radiological planes (anteroposterior and frog-lateral) is a simple measurement of the posteroinferior translation of the femoral head relative to the femoral neck in SCFE. It is a measurement of the true deformity of the proximal femur in SCFE. Calculation of FHNTR may be applicable to classify SCFE, to monitor femoral head-neck remodeling after slip stabilization, to describe the femoral head-neck relation in healthy individuals, and to monitor femoral head-neck changes secondary to other hip pathology, such as Perthes disease or developmental dysplasia of the hip.

Extravasation injuries are frequent complications, especially in extremely preterm neonates treated in neonate intensive care units (NICU). Depending on the type of the extravasated substance, the duration, and the amount of the leak, extravasation may result in necrosis of the soft tissues adjacent to the leak, compartment syndrome, and limb amputation. However, in some cases, the results of extravasation may be evident years after NICU treatment. In this case report, we describe a rare case of physeal arrest of the distal tibia in a preterm and discuss the possible causes.