J. Warren White

Chondrodystrophia calcificans congenita; report of a case.

In summary, the authors feel that this case, presented roentgenographically, demonstrates, See Images in the PDF file as in a slow-motion picture, the uninterrupted course of events in chondrodystrophia calcificans congenita. The sequence of events leading to fusion of the areas of stippling of the epiphyses is demonstrated. It appears that there is a definite variation in the degree of involvement in the different cases reported, and that those cases with marked involvement and with associated anomalies have a poorer prognosis. The authors feel that the manifestations constitute a definite chondrodysplasia with variation in potentiality in regard to the eventual effect on completion of development.

SKIN-TIGHT CASTS FOR TREATMENT OF CLUB-FOOT

Tine conservative ti-eatment of congenital talipes equinovarus is usually the wedgedtn-n-st nnefhotl, olescnibetl by Kite, or the splint method of Denis Browne. Excellent results un-n-ye been reporten-i from the use of either of these methods,-Kite reports successful treatment inn 90 per cent. of his eases. Tinere are certain n-iisadvantages associated with both methods : the Kite cast requires frequent. wedging, w’hich involves many trips to the hospital on the part of the patient, n-n-nd time-constuming, meticulous care on the part of the physician in taking the wedge and applying the casts. It also requires the plaster to be extended above the knee to prevent tine cast fi-om slipping off in the earlier stages of correction. The Denis Browne splint reqn-nires almost. cn-)onstant attention, for the adhesive strapping must be changed even-y five 10) seven-n n-lays, entailing freqmuent inospital trips or long periods of hospitalization at consit!erable expelnse. Tue method t)f freafnnent t.o be described is the use of skin-tight casts witin spongen’mibitt’i I) t(I5 w’inicln maintain, without wedging, a corrective kinetic force for two weeks or mo)1-e. WC bo’lieve it inas tuniqn-ne advantages. ‘l’ine skin t)f tine foot an-sd ankle is painted with compon-und tinctum-e of benzoin or an n-n-dinerent. Witin oine hand, an assistant holds the foot by the toes in the desired position, ann-I witin the other hand inc holds the leg just above the knee, with the knee flexed. Three pads O)f n-iun-trtei-inch thick sponge rubber are cut, usually one and one-half inches square for the nenvborn and vai-ying for older children with the size of the foot to be treated. These pan-Is are placed next to the skin,-one over the medial side of the first metatarsophalangeal joint, rn-inning proximally a little; one over the sinus tarsi and cuboid on the lateral side of the foot ; amnd one just back of the heel. These are held in place by the sticky adinerent, which also prevents the short plaster from slipping. A circular, skin-tight plaster cast is then applieoi from the tips of the toes to just below the knee. As the plaster is setting, tine sn-urgeon grasps the foot as shown in Figures 1 and 2, the left hand for the left foot, an-nd fine right hand for the right foot. The thumb passes under the sole, with the ball of tine tinn-n-mb n-under the cn-n-boid, the index finger across the dorsum, and the long finger behind the heel. Wit.in tinis grasp, the surgeon has excellent control of all three components in the deformity of the foot, and he may mold the plaster and correct. at tine same time, using the free hand to assist and smooth the plaster. After the plaster has set, a short length of elastic bandage is wrapped around the top of the cast to “get rid of the edge of tine cast “. The completed cast is shown in Figure 3. It is felt that not only is it n-n-nnecessary to) cam y fine cast above tine knee, bn-n-t also that the employment. of the thigh element with a flexed knee to gain an-n external rotation correction of tine leg constit.n-utes an unwarnanten-I strain on fine knee. Dn-uring the pci-ion-i t)f active correction, the cast is changed only at two-week intervals. It is ustually true f.inat tine foot which inas not been previously treated is completely conrected at tine cnn-i of six to seven plaster changes, and the last plaster is allowed to remain on for from three to fon-n-r weeks as a holding plaster. The principles and sequence of correction as laid down by Kite are followed. As a matter of record, all feet are examined by means of roentgenograms, regardless of the patient’s age, before treatment is started. The adduction of the fore part of the foot is corrected first, followed by correction of the inversion. This stage is usually reached at the