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Test Paper 1
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Spontaneous osteonecrosis of the knee (SONK) is a rapid and painful condition in elderly patients that ultimately results in subchondral collapse of the weight-bearing portion of the medial femoral condyle. It is often idiopathic but can be associated with minor trauma. It is now also increasingly recognised as a subchondral insufficiency fracture resulting in rapid secondary subchondral collapse. Perthes disease is a childhood disease with avascular necrosis of the femoral head. Sinding–Larsen disease is essentially tendinosis of the proximal origin of the patella tendon. Blount’s disease is a growth disorder of the tibia resulting in a ‘bow leg’ deformity from disturbance to the medial proximal tibial epiphysis. An osteochondral defect is a traumatic injury involving the articular cartilage and adjacent subchondral bone.
Genu varum
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
Plain radiographs of Blount’s disease often give an impression of a depressed medial tibial condyle – an appearance recognised as one of the more advanced Langenskiöld stages of tibia vara.10,11 The tibial joint line has the appearance of a tilted ‘pitched roof’ but the radiograph may be misleading – the ‘incomplete’ medial tibial condyle may represent unossified cartilage. Magnetic resonance imaging (MRI) and arthrography will show the true joint level on the medial side – these investigations are important lest an unwary surgeon attempts to ‘elevate’ the medial side.11 If there is a true underdevelopment of the medial tibial condyle on MRI (clinical suspicion is raised if there is significant laxity to valgus stressing), treatment would then need to include an elevation of the hemiplateau.12 (See Chapter 67, Blount’s disease)
The Knee
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
Blount’s disease is a progressive bow-legged deformity due to abnormal growth of the posteromedial part of the proximal tibia. It tends to affect children of black African descent more frequently than others. Typically, and in the adolescent variety, the child is overweight and walks with an outward thrust at the knee. On x-ray, the proximal tibial epiphysis is flattened medially and the adjacent metaphysis is beak shaped. Spontaneous resolution is rare. Hemi-epiphyseodesis may not always work and correction by osteotomy is usually needed.
Characterizing attendance patterns at a multidisciplinary pediatric obesity clinic
Published in Children's Health Care, 2020
Anne S. Morrow, Shanda Sandridge, Whitney Herring, Krista King, Sophie Lanciers, Crystal Stack Lim
Given the severity of the sample (53.8% meeting criteria for severe obesity), perhaps future research could leverage methodologies such as single-subject design studies and case reports to capture the rich data necessary to investigate and improve treatment in this unique sample. Take, for example, an 11.7-year-old girl in our sample who weighed 266.8 lbs at her baseline visit. She had several medical complications, including Blount’s disease. She never returned for a follow-up visit, and she lived about an hour away from the clinic. A 12.2-year-old boy who weighed 358.5 lbs came to the initial visit and four of four follow-ups, also traveling from about an hour away. He returned to the clinic after 70 days, followed by visits 31 days later, 42 days later, and 39 days later. He was diagnosed with multiple comorbid disruptive behavior disorders and taking multiple psychiatric medications. To our knowledge, there is no other multidisciplinary pediatric obesity clinic within approximately 200 miles of our location. Both children met the criteria for class III severe obesity at baseline. Single-case study designs would be helpful with respect to the collection of much-needed idiographic data on involvement in pediatric obesity interventions (e.g., information on varied, low base-rate medical complications), vs. the majority of existing research using a nomothetic approach (e.g., attrition, BMI).
Blount’s disease successfully treated with intraepiphyseal osteotomy with elevation of the medial plateau of the tibia—a case report with 65 years’ follow-up
Published in Acta Orthopaedica, 2018
Terje Terjesen, Darko Anticevic
Severe varus deformity should be surgically corrected; if left untreated, OA predictably occurs early in life (Hofmann et al. 1982). It is, however, difficult to evaluate the association between deformity following Blount’s disease and OA, because follow-up in most studies is too short. The longest previous follow-up after elevation osteotomy of the tibial plateau seems to be in a patient aged 41 years (Langenskiöld 1989). The follow-up time of our patient was 65 years (patient age 78 years) and thus more than long enough for a proper evaluation of OA. Surprisingly, only moderate OA had developed during this long time. This shows that a good result at skeletal maturity in a patient with severe preoperative varus (Støren 1969) can remain good even with long follow-up if the deformity has been adequately corrected.