Introduction: Congenital dislocation of the patella (CDP) is a rare condition and its treatment is not well defined. In CDP, patella is dislocated on the lateral aspect of the distal femur, laterally from the trochlear groove, it cannot be reduced manually and it is almost always associated with genu valgum, lateral torsion of the proximal tibia, and flexion contracture of the knee. This condition is present at birth, but the clinical findings can be subtle at birth due to the size and character of the structures being examined; early diagnosis is essential, but it may be delayed to late childhood or adulthood. If CDP is not promptly treated, the disability increases during growth, so surgical correction should be planned as soon as the diagnosis is confirmed.
Case Report: We report a case of bilateral CDP associated with bilateral proximal radioulnar joint stiffness; the patient at the age of diagnosis was 11 years old and underwent a bilateral delayed surgical procedure; the 4-year follow-up results are satisfactory. Surgical treatment rationale and literature are reviewed.
Conclusion: Surgical correction for CDP is generally recommended, but there is no agreement in literature on the ideal treatment and in some cases, with mild impairment of the knee function, observation alone has been suggested. The decision about a surgical treatment can be difficult and depends on the degree of disability of the patient.
Keywords: Congenital dislocation of the patella, bilateral congenital dislocation, patella, Z-plasty quadriceps muscle, lateral retinaculum release, lack of active knee extension.
SummaryBackground and aims. Although several studies have demonstrated a higher incidence of bone disorders in HCV-infected adults, the bone turnover alterations occurring in children and adolescents with chronic hepatitis C has not been thoroughly focused yet. We performed a study on a cohort of 30 HCV infected caucasian children and adolescents to assess the prevalence of osteodystrophy and evaluate a possible prophylactic and therapeutic approach. Methods. Data regarding biochemical markers of bone metabolism were collected. Moreover, results of ultrasonographic bone densitometry yearly performed were evaluated in comparison with data obtained from more than 500 healthy children and adolescents. Results. Osteocalcin and telopeptide of the collagen molecule type-1, CTX, appeared higher than normal in 8/30 and in 7/30 cases respectively; the 25OH vitamin D values were normal in 25/28 cases. By densitometry osteoporosis was detected in 2 patients and osteopenia in other 5. After stratification of cases by age groups, the incidence of osteopenia/osteoporosis appeared higher among children than among adolescents. Osteocalcin levels tended to be higher in cases where hepatic fibrosis were not detected. Conclusions. The higher number of cases of osteopenia/osteoporosis in children than in adolescents is wor-
Abstract:Background: MMP-2 and MMP-9 are proteolytic enzymes involved in the remodeling of extracellular matrix and regulated in their function by a family of proteins called TIMPs. MMP-2 and MMP-9 and TIMPs are secreted in joints by both synovial cells and chondrocytes, and are implicated in osteoarthritis onset and progression. The aim of this study was to investigate the localization of MMP-2 and TIMPs expression and their relationship in the synovial membrane of equine fetlock (metacarpo-phalangeal joint), which is the joint most frequently affected by osteoarthritis due to his high weight-bearing impact and shearing forces. Method: This study analyzed the immunohistochemical expression of MMP-2 and tissue inhibitors of MMP (TIMPs) in synovial membrane sections from 40 equine metacarpo-phalangeal joints affected by osteoarthritis in order to better assess their role in the pathogenesis of joint-structure alterations. Immunohistochemical study was performed using the Avidin-Biotin-Peroxidase complex method, and the percentage of labeled cells was assessed semi-quantitatively. Data obtained were statistically revised through the Spearman's rank correlation coefficient. Results: MMP-2 and TIMPs were expressed by type-B synoviocytes and endothelial cells. MMP-2 expression was not significantly associated to the macroscopic findings while a linear correlation between MMP-2 and TIMPs expression was observed. Conclusion: These data suggest that in degenerative joint disease the synovial expression of TIMPs may contribute to the regulation of MMP-2 expression in order to reach a new dynamic balance and that MMP-2 plays an important pro-homeostatic role in physiological and pathological equine synovial membrane.
A 4 months and half female child come to our attention for congenital dislocation of the left hip, previously treated in another hospital with abduction bracing, without satisfactory results. After progressive longitudinal bilateral traction, closed reduction under general anesthesia was performed and a spica cast was applied in the so-called human position. The patients remained in the spica cast for 6 weeks and then the plaster cast was renewed in narcosis for another 6 weeks. Once the second cast has been removed left femoral nerve palsy was detected. Orthopaedic treatment was interrupted and in 3 months the nerve completely recovered, while the hip was still stable. We followed the child regularly since then, she is now five years old, she is totally asymptomatic, X-rays shows a residual acetabular dysplasia, with no sign of avascular necrosis.
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