BackgroundThe epiphysis is a rather uncommon location of hematogenous osteomyelitis involvement. Because the transphyseal arteries vanish about 15-18 months of age, epiphyseal osteomyelitis was previously assumed to occur mainly in newborns under one year of age.Methods and Results In this case report, we present three cases of epiphyseal osteomyelitis who are older than 18 months. Most doctors believe that epiphyseal osteomyelitis caused by bacteria often has a good prognosis and cures without long-term complications. In our study, one patient underwent timely aggressive surgical treatment combined with antibiotic therapy in the early course of the disease. Seven months after surgery, his laboratory examinations were normal with no evidence of recurrence. But he had limited flexion and extension of the knee, and the range of motion was 20°- 100°. This complication was not reported in any of the previous studies. ConclusionsThe diagnosis of epiphyseal osteomyelitis is often delayed because of silent symptoms, mild radiological changes, and atypical location. Physicians should be aware of the clinical and radiographic features of this disease so that it can be diagnosed and treated as soon as possible to prevent further development and complications.

BackgroundTo quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use Magnetic resonance imaging(MRI) to evaluate changes in the tarsal bones relationship. MethodsThis is a retrospective study of 12 children with clubfoot treated with Ponseti method. MRI studies were obtained using a 3.0T machine(GE, America). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle and transverse talocalcaneal angle were measured. The 15 corrected clubfoot were compared with the 9 unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.Results12 patients (10 boys, 2 girls) with clubfoot were examined by using MRI. 9 cases had unilateral and 3 had bilateral involvement(8 left clubfoot, 7 right clubfoot), giving a total of 15 clubfoot compared with 9 normal feet. The mean age of patients at examination was 47.7months (8-96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment(functional, normal looking, pain-free, plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5(5-6). During this follow-up, the Pirani score was 0.07(0-0.05). The results of MRI indicated that only the transverse talonavicular angle showed significant difference between the treated clubfoot and the normal feet(P< 0.001). 1 of 15 of the corrected clubfoot had dorsal talonavicular subluxation in sagittal plane and 1 had lateral subluxation of the navicular in transverse plane, which have never been reported in previous studies.ConclusionsAlthough the appearance and function of clubfoot recovered well after the Ponseti method, the results of MRI indicated that Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in sagittal plane and lateral subluxation of the navicular in transverse plane on MRI.

ObjectiveTo quantitatively evaluate the effectiveness of the Ponseti method for the correction of clubfoot, we decided to use magnetic resonance imaging (MRI) to evaluate changes in the tarsal bone relationship.MethodsThis is a retrospective study of fifteen children with clubfeet who were treated with the Ponseti method. MRI studies were obtained using a 3.0T Machine (GE Healthcare, United States). T1-weighted and T2-weighted images were acquired in the standard anatomic sagittal, transverse, and coronal planes. For the measurement, the best slice that clearly demonstrated the anatomy was chosen. Sagittal talocalcaneal angle, sagittal tibiocalcaneal angle, coronal tibiocalcaneal angle, transverse talar neck angle, transverse talonavicular angle, and transverse talocalcaneal angle were measured. The eighteen corrected clubfeet were compared with the twelve unilateral normal feet at clinical and radiological levels using a Pirani scoring system and MRI, respectively.ResultsIn total, 15 cases (twelve boys and three girls) with clubfeet were examined by using MRI. Twelve cases had unilateral and three had bilateral involvement (eleven left clubfeet and seven right clubfeet), giving a total of eighteen clubfeet when compared with twelve normal feet. The mean age of patients at examination was 47.7 months (8–96 months). The recovery of the corrected clubfoot in these patients met the goals of Ponseti treatment (functional, normal looking, pain-free, and plantigrade foot). Before Ponseti treatment, the mean Pirani score of clubfoot was 5.5 (5–6). During this follow-up, the Pirani score was 0.07 (0–0.05). The results of the MRI indicated that only the transverse talonavicular angle showed a significant difference between the treated clubfeet and the normal feet (p &lt; 0.001). One case had dorsal talonavicular subluxation in the sagittal plane and had the lateral subluxation of the navicular in the transverse plane, which has never been reported in previous studies.ConclusionAlthough the appearance and function of clubfoot were recovered well after the Ponseti method, the results of MRI indicated that the Ponseti method successfully corrected the varus, cavus, and equinus deformities and incompletely corrected the adduction deformity regarding transverse talonavicular angle. At the same time, the Ponseti method may cause dorsal talonavicular subluxation in the sagittal plane and lateral subluxation of the navicular in the transverse plane on MRI.

Congenital talipes equinovarus (CTEV) is one of the most common congenital limb defects in children, which is a multifactorial and complex disease that associates with many unknown genetic, social-demographic, and environmental risk factors. Emerging evidence proved that gene expression or mutation might play an important role in the occurrence and development of CTEV. However, the underlying reasons and involved mechanisms are still not clear. Herein, to probe the potential genes and related signaling pathways involved in CTEV, we first identified the differentially expressed genes (DEGs) by mRNA sequencing in pediatric patients with CTEV compared with normal children. The gene of COL1A2 was upregulated, and AKT3 was downregulated at the transcriptional level. Western blot and quantitative polymerase chain reaction (qRT-PCR) results also showed that the expression of COL1A2 in CTEV was enhanced, and the AKT3 was decreased. Furthermore, the COL1A2 Knock-in (+COL1A2) and AKT3 Knock-out (-AKT3) transgenic mice were used to verify the effects of these two genes in the CTEV, and the results of which showed that both COL1A2 and AKT3 were closely related to the CTEV. We also investigated the effect of the PI3K-AKT3 signaling pathway in CTEV by measuring the relative expression of several key genes using Western blot and qRT-PCR. In line with the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis data, the PI3K-AKT3 signaling pathway might play a potentially important role in the regulation of pathological changes of CTEV. This study will provide new ideas for the mechanism investigation and prenatal diagnosis of CTEV.