Objective This study aimed to evaluate the influence of three different inclinations of the incisal edge of Planas direct tracks (PDTs) on the upper deciduous incisors (15, 30, and 45 degrees) through simulations using the finite-elements method. Materials and Methods A three-dimensional virtual model of tooth 51 was elaborated by using the Rhinoceros computer-aided design (CAD) software. A mesh was constructed by using the Patran software, and the evaluations were processed by using the ANSYS 15.0 software. The geometry of the elements used consisted of a triangular-base tetrahedron composed of 2,167,386 elements and 3,012,995 nodal points. Results Progressive alterations of proportional intensity and distribution were seen in the areas of tension on the dentoalveolar structures, with increasing inclination of the edge of the PDT. The tractive contact tensions were seen to be concentrated in the vestibular apical thirds and palatine cervical thirds, while the compressive contact tensions were in the palatine apical thirds and vestibular cervical thirds. Conclusion It was concluded that a 30-degree inclination for the PDT was most appropriate for the cases of anterior crossbite in the deciduous dentition. Nevertheless, because this was a laboratory evaluation, clinical criteria and complementary examinations for each case need to be taken into consideration in making therapeutic decisions.

PurposeThe overriding fifth toe is a congenital triplane deformity that may cause aesthetic and functional concerns in children and adolescents. This study aims to evaluate the results obtained when using Butler’s arthroplasty to treat this forefoot deformity.MethodsWe performed a retrospective study, including all patients undergoing Butler’s arthroplasty from January 1995 to December 2012. Clinical records were reviewed to determine age at date of surgery, gender, laterality, preoperative symptoms, success of deformity correction, postoperative pain, scarring, need for adapted shoe, rates of complications and recurrence. Patient satisfaction was evaluated through a telephone interview. All p-values < 0.05 were considered statistically significant.ResultsA total of 21 patients were included in this study, the majority of which were male (57%), with a mean follow-up of 12 months (1 to 52). In the evaluation of the residual deformity (18 patients), 72% had excellent results, 17% good and 11% poor results. One patient had a keloid scar, three patients reported pain and three patients required adapted footwear. There was a partial recurrence of the deformity in three cases. The majority of patients (78%) were satisfied with the surgery. There was no statistically significant difference in terms of results, when comparing patients older and younger than seven years of age (p = 0.46).ConclusionsButler’s operation is effective and safe in the treatment of the overriding fifth toe, yielding good functional results and patient satisfaction, with low rate of complications.Level of EvidenceIV

A male infant showed a humeral diaphysis fracture at 5 months of age and a distal tibial physis fracture at 2 years of age. A specialized consultant ruled out child abuse. This child had the characteristic features of type I osteogenesis imperfecta: blue sclerae, osseous fragility, and presumably autosomal dominant inheritance, as his father suffered from similar disorders. Later on, multiple painful osteochondromas were also found and some of these were surgically treated. The child's mother showed several peripheral osteochondromas. We describe the follow-up of this patient up to the age of 18 years. To our knowledge, the fortuitous association of these two inherited conditions has not been reported in medical literature.

Subungual exostosis is a rare benign osteocartilaginous tumor, of unknown etiology, that affects the subungual part of the distal phalanx and predominantly affects adolescent females. The objective of this study is to evaluate the results of surgical treatment of subungual exostosis in pediatric patients by means of surgical excision and nail preservation. We present a retrospective study, including pediatric patients with subungual exostosis who underwent surgical treatment in a single institution, over a 6-year period, We describe the surgical technique used, the characteristics of the patients and lesions, and evaluate the results obtained in terms of function, satisfaction and complications. Thirteen patients were included in this study, seven female (54%) and six male (46%), median age 11 years old. The most common location was the hallux, in eight patients (73%). Patients had good functional results with a median American Orthopedic Foot & Ankle Society score of 100 [80; 100] and a median personal satisfaction score of 9. The median follow-up was 30 [3;68] months. In our patients, subungual excision with nail bed preservation, allows a good balance between the radical excision of the exostosis and the preservation of the natural protection granted by the native nail, yielding good functional results and patient satisfaction.