BACKGROUND Müller-Weiss disease(MWD)is an idiopathic foot condition characterized by spontaneous tarsal“scaphoiditis”in adults.Frequently bilateral and affecting females during the 4th-6th decades of life,the p...BACKGROUND Müller-Weiss disease(MWD)is an idiopathic foot condition characterized by spontaneous tarsal“scaphoiditis”in adults.Frequently bilateral and affecting females during the 4th-6th decades of life,the pathogenesis of MWD remains unclear:It has been traditionally considered a spontaneous osteonecrosis of the navicular.The typical presentation of MWD is a long period of subtle discomfort followed by prolonged standing,atraumatic,disabling pain.Currently,there is no gold standard for the treatment of patients with MWD.Most support initial conservative therapy.Operative treatment should be considered for failure of conservative therapies longer than 6 months.The indication for surgery is severity of symptoms rather than severity of deformities.Operative treatment options include core decompression,internal fixation of the tarsal navicular,open or arthroscopic triple fusion,talo-navicular or talo-navicular-cuneiform arthrodesis,and navicular excision with reconstruction of the medial column.CASE SUMMARY In this study,we report four patients affected by MWD.Clinical and radiographic assessment,follow-up and treatment are reported.CONCLUSION As it is frequently misdiagnosed,MWD is challenging for orthopedic surgeons.Early diagnosis and effective treatment are mandatory to avoid sequelae.展开更多
BACKGROUND Primary synovial chondromatosis(PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may u...BACKGROUND Primary synovial chondromatosis(PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal;the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC,choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot,particularly the subtalar joint, due to the high risk of arthritic evolution.展开更多
BACKGROUND Talar fractures are exceedingly rare in childhood.There are very few studies on the clinical aspects,the long-term outcomes and the appropriate treatment of these fractures in pediatric patients.The mechani...BACKGROUND Talar fractures are exceedingly rare in childhood.There are very few studies on the clinical aspects,the long-term outcomes and the appropriate treatment of these fractures in pediatric patients.The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot.Traumatic mechanism,symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia:the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close.CASE SUMMARY A thirteen-year-old girl reported a high-energy trauma to her right foot,due to falling from her horse.X-rays at the Emergency Department were negative.Because of persistent pain,the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head.Hence,surgical open reduction and fixation with two headless screws was performed.The girl was assessed regularly,and plain films at follow-up revealed complete healing of the fracture.Within six months after surgery,the patient returned to pre-injury sport activities reporting no complications.CONCLUSION Injuries of the talar head in childhood should be considered as transitional fractures.Open reduction with internal fixation aims to reduce malalignment and osteoarthritis.Computed tomography scans are recommended in these cases.展开更多
文摘BACKGROUND Müller-Weiss disease(MWD)is an idiopathic foot condition characterized by spontaneous tarsal“scaphoiditis”in adults.Frequently bilateral and affecting females during the 4th-6th decades of life,the pathogenesis of MWD remains unclear:It has been traditionally considered a spontaneous osteonecrosis of the navicular.The typical presentation of MWD is a long period of subtle discomfort followed by prolonged standing,atraumatic,disabling pain.Currently,there is no gold standard for the treatment of patients with MWD.Most support initial conservative therapy.Operative treatment should be considered for failure of conservative therapies longer than 6 months.The indication for surgery is severity of symptoms rather than severity of deformities.Operative treatment options include core decompression,internal fixation of the tarsal navicular,open or arthroscopic triple fusion,talo-navicular or talo-navicular-cuneiform arthrodesis,and navicular excision with reconstruction of the medial column.CASE SUMMARY In this study,we report four patients affected by MWD.Clinical and radiographic assessment,follow-up and treatment are reported.CONCLUSION As it is frequently misdiagnosed,MWD is challenging for orthopedic surgeons.Early diagnosis and effective treatment are mandatory to avoid sequelae.
文摘BACKGROUND Primary synovial chondromatosis(PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal;the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC,choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot,particularly the subtalar joint, due to the high risk of arthritic evolution.
文摘BACKGROUND Talar fractures are exceedingly rare in childhood.There are very few studies on the clinical aspects,the long-term outcomes and the appropriate treatment of these fractures in pediatric patients.The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot.Traumatic mechanism,symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia:the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close.CASE SUMMARY A thirteen-year-old girl reported a high-energy trauma to her right foot,due to falling from her horse.X-rays at the Emergency Department were negative.Because of persistent pain,the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head.Hence,surgical open reduction and fixation with two headless screws was performed.The girl was assessed regularly,and plain films at follow-up revealed complete healing of the fracture.Within six months after surgery,the patient returned to pre-injury sport activities reporting no complications.CONCLUSION Injuries of the talar head in childhood should be considered as transitional fractures.Open reduction with internal fixation aims to reduce malalignment and osteoarthritis.Computed tomography scans are recommended in these cases.
