Kenan Saridogan

Magnetic resonance imaging in follow-up of treated clubfoot during childhood

In this study, we evaluated the short-term results of surgically treated clubfoot with magnetic resonance imaging (MRI). T1- and T2-weighted MRI images with 4-mm slices in the standard anatomic sagittal, transverse, and coronal planes were obtained in seven cases of clubfoot aged 4--11 years (mean 5.6 years old). The mean follow-up period was 3.6 years (ranged between 2 and 6 years). Sagittal talocalcaneal angle, talar head and neck axis internal rotation, calcaneal axis internal rotation, transverse talar neck and head/calcaneus angle and posterior calcaneus external rotation were measured. Three cases with dorsal talonavicular subluxation and a case of calcaneocuboid luxation were demonstrated by MRI. It was concluded that MRI may help to understand results of surgically-treated clubfoot by revealing hindfoot articular relationships and many complications.

Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index.

Background: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH). Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. Materials and Methods: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. Results: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. Conclusions: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.

A 10-year-old boy with limping complaint.

A 10-year old boy who had a history of diarrhea and fever approximately 4 weeks before presentation and whose complaints improved with symptomatic treatment in that period without use of antibiotics presented to our outpatient clinic with pain, swelling, erythema and limping in the left foot. On physical examination, erythema, increased temperature and tenderness on the dorsum of the left foot and a purulent bulla with a size of 3 x 3 cm on the dorsolateral part of the 5th metatarsophalengeal joint were noted (Figure 1). The patient and his family reported that pain and limping in the left foot started two days after diarrhea stopped and increased gradually for the last three weeks. Swelling, erythema and increased temperature started 5 days before presentation and reached the status at the time of presentation. At presentation, the white blood cell (WBC) count in the peripheral blood was found to be 11 200/mm3, C-reactive protein (CRP) was found to be 5,94 mg/dL and erythrocyte sedimentation rate (ESR) was found to be 40 mm/h. Foot radiographs were found to be normal. On magnetic resonance imaging, Brodie abscess starting from the distal metaphysis of the 5th metatarsal bone of the left foot and extending to the subcutaneous tissue and soft tissue edema in the periarticular area were observed (Figure 2). No growth occured in urine, stool and blood culture samples obtained at presentation.