The Akron dome midfoot osteotomy as a salvage procedure for the treatment of rigid pes cavus - A retrospective review
arthrodesis; calcaneocavus; cavus deformity; claw-foot; clubfeet; deformity; feet; Orthopedics; osteotomy; Pediatrics
Objective: In the early 1970s, the Akron dome osteotomy was developed as a salvage surgical option to manage rigid cavus deformity of the foot. This study represents an updated review of surgical cases between 1972 and 2001 constituting 89 patients representing 139 feet who were followed at least 2 years after the index operative procedure. Only cases achieving an unsatisfactory result followed less than 2 years were included. Study Design: A retrospective review of cases (all operated by D.S.W) was conducted by clinical examination and chart review of all 89 cases representing 139 feet. Results: A satisfactory result was considered pain-free, at least 75% plantigrade foot in contact with the floor without abnormal symptomatic pressure areas, free of any significant deformity requiring surgical management. A satisfactory result was obtained in 106 (76%) and unsatisfactory result in 33 feet (24%). When separating the patients into those younger than 8 years and those older than 8 years, 67% of the patients younger than 8 years had a satisfactory result, and 82% older than 8 years had a satisfactory result. No significant complications were encountered. Because the surgery is located at the apex of the deformity in frontal, lateral, and plantar planes at the confluence of the longitudinal and transverse arches, multiplanar surgical correction was obtained in all cases at the time of the initial surgery. Currently, the most common causes of cavus deformity seen in our series were the sequelae of idiopathic talipes equinus varus clubfoot, congenital metatarsus varus, and assorted neuromuscular disorders, including Charcot-Maric-Tooth disease, cerebral palsy, and arthrogryposis. Conclusions: On the basis of this review, the Akron dome midfoot osteotomy is a very valuable salvage procedure in the management of the rigid cavus deformity in children. Level of Evidence: Level III.
Weiner D S; Morscher M; Junko J T; Jacoby J; Weiner B
Journal of Pediatric Orthopaedics
2008
2008-01
Journal Article
<a href="http://doi.org/10.1097/bpo.0b013e31815a5fba" target="_blank" rel="noreferrer noopener">10.1097/bpo.0b013e31815a5fba</a>
The early radiations of cetacea (Mammalia): Evolutionary pattern and developmental correlations
archaeocete; artiodactyls; development; Environmental Sciences & Ecology; evolution; Evolutionary Biology; feet; fossil record; India; locomotor evolution; marine mammal; middle eocene; origin; pakistan; Stenella attenuata; time; whales
The origin and early evolution of Cetacea (whales, dolphins, and porpoises) is one of the best examples of macroevolution as documented by fossils. Early whales are divided into six families that differ greatly in their habitats, which varied from land to freshwater, coastal waters, and fully marine. Early cetaceans lived in the Eocene (55-37 million years ago), and they show an enormous morphological diversity. Toward the end of the Eocene the modem cetacean body plan originated, and this body plan remained more or less the same in the subsequent evolution. It is possible that some aspects of this body plan are rooted in constraints that are dictated by cetacean embryologic development and controlled by genes that affect many organ systems at once. It may be possible to use a study of patterns of correlations among morphological traits to test hypotheses of developmental links among organ systems.
Thewissen J G M; Williams E M
Annual Review of Ecology and Systematics
2002
2002
Journal Article
<a href="http://doi.org/10.1146/annurev.ecolysis.33.020602.095426" target="_blank" rel="noreferrer noopener">10.1146/annurev.ecolysis.33.020602.095426</a>
Vestibular evidence for the evolution of aquatic behaviour in early cetaceans
artiodactyls; bony labyrinth; feet; hearing; inner-ear; locomotor evolution; model; origin; petrosal; Science & Technology - Other Topics; whales
Early cetaceans evolved from terrestrial quadrupeds to obligate swimmers, a change that is traditionally studied by functional analysis of the postcranial skeleton(1). Here we assess the evolution of cetacean locomotor behaviour from an independent perspective by looking at the semicircular canal system, one of the main sense organs involved in neural control of locomotion(2). Extant cetaceans are found to be unique in that their canal arc size, corrected for body mass, is approximately three times smaller than in other mammals. This reduces the sensitivity of the canal system, most plausibly to match the fast body rotations that characterize cetacean behaviour. Eocene fossils show that the new sensory regime, incompatible with terrestrial competence, developed quickly and early in cetacean evolution, as soon as the taxa are associated with marine environments. Dedicated agile swimming of cetaceans thus appeared to have originated as a rapid and fundamental shift in locomotion rather than as the gradual transition suggested by postcranial evidence. We hypothesize that the unparalleled modification of the semicircular canal system represented a key 'point of no return' event in early cetacean evolution, leading to full independence from life on land.
Spoor F; Bajpal S; Hussaim S T; Kumar K; Thewissen J G M
Nature
2002
2002-05
Journal Article
<a href="http://doi.org/10.1038/417163a" target="_blank" rel="noreferrer noopener">10.1038/417163a</a>
The Orthopaedic Manifestations of Pseudoachondroplasia
Achondroplasia; Apoptosis; Arthritis; Biomechanics; Bone (axial); Bone dysplasia; Bones; Cartilage; Cartilage (articular); Cartilage oligomeric matrix protein; Chondrocytes; Chromosome 19; Chromosomes; Dwarfism; Dysplasia; Elbow; Elbow (anatomy); Epiphysis; Extremities; Feet; Gait; Hand (anatomy); Hip; Intelligence; Joint diseases; Knee (anatomy); Kyphosis; Medical Sciences--Pediatrics; Mutation; Orthopedics; Plates (structural members); Proteins; Radiographs; Radiography; Skeleton; Thorax; Vertebra; Vertebrae
October 2019 Update
In 1959, Maroteaux and Lamy initially designated pseudoachondroplasia as a distinct dysplasia different from achondroplasia, which is the most common form of skeletal dysplasia associated with dwarfism. Pseudoachondroplasia is the second-most common form of skeletal dysplasia. Pseudoachondroplasia is caused by a mutation in the COMP gene on chromosome 19p13.1-p12 encoding the cartilage oligomeric matrix protein. The mutation causes an accumulation of mutated COMP protein within the rough endoplastic reticulum of chondrocytes leading to premature chondrocyte apoptosis. This cascade of molecular events eventually results in rendering the articular cartilage and growth plate cartilage incapable of withstanding routine biomechanical loads with resultant deformity of the joints, particularly in the lower extremities. A unique opportunity to review charts and radiographs of 141 patients with pseudoachondroplasia allowed the author to assemble the typical findings in pseudoachondroplasia. This cohort, to our knowledge, represents the largest group of patients describing the typical orthopaedic manifestations of pseudoachondroplasia. The intensive review of this cohort yielded the following clinical and radiographic information: Patients with pseudoachondroplasia have a normal craniofacial appearance and are of normal intelligence. Short stature is not present at birth and generally appears by 2 to 4 years of age. The condition is a form of spondyloepiphyseal dysplasia and the long bones are characterized by dysplastic changes in the epiphysis, metaphysis, and vertebral bodies. The hands have short, stubby fingers, short metacarpals, lax wrists, diminished extension of the elbow, and limitation of shoulder motion. Occasionally odontoid dysplasia is seen with kyphosis, scoliosis, and lumbar lordosis, commonly. The gait is characterized by "waddling". The knees show either genu valgum, genu varum, or "windswept" deformity and the feet and ankles are in pronovalgus position with short, wide feet. Radiographically the long bones have altered appearance and structure of the epiphyses with small irregularly formed or fragmented epiphyses or flattening. The metaphyseal regions of the long bones show flaring, widening, or "trumpeting". The cervical vertebrae show platyspondyly. The thoracic and lumbar vertebrae show either platyspondyly, ovoid, "cod-fish" deformity, or anterior "beaking". Most commonly these distortions of the long bones and the axial skeleton, lead to premature arthritis particularly of the hips and often the knees not uncommonly in the 20- to 30-year-old age group. Vertebral "beaking" (Image 1) Epimetaphyseal dysplasia (Image 2)
Guirguis James; Weiner Dennis S
Pediatrics; Evanston
2019
2019-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1542/peds.144.2_MeetingAbstract.755" target="_blank" rel="noreferrer noopener">10.1542/peds.144.2_MeetingAbstract.755</a>