Genomic fingerprints of Staphylococcus aureus of bovine origin by polymerase chain reaction-based DNA fingerprinting

Staphylococcus aureus (n = 75) isolated from mammary secretions of cows with subclinical and clinical mastitis from several geographic locations in the USA were examined using polymerase chain reaction-based DNA fingerprinting. DNA fingerprints were produced using a synthetic oligonucleotide primer (5'GTAACGCC3') to produce a distinct spectrum of amplified DNA fragments facilitating a high degree of resolution for differentiating S. aureus strains. PCR-based DNA fingerprinting grouped the 75 S. aureus isolates into 19 distinct profiles. The technique differentiated closely related strains within and between geographic locations. Findings suggest that certain types are found across geographic regions suggesting a common clonal type. Within herd data suggest heterogeneity among subclinical and clinical isolates of S. aureus strains. Compared to existing typing methods, PCR-based DNA fingerprinting is easy to perform and interpret. Use of PCR-based DNA fingerprinting may allow for a more detailed investigation of the epidemiology of S. aureus mastitis in dairy cows.

Fibular transfer for congenital absence of the tibia

Twelve patients (13 extremities) who had complete congenital absence of the tibia were treated between 1963 and 1989. Three patients (three extremities) had a knee disarticulation performed as the primary procedure because they had no quadriceps function. Nine patients (10 extremities) underwent centralization of fibula under the femoral condyles (Brown procedure). Four of these 10 extremities developed a severe flexion contracture of the knee (> 25 degrees) and underwent subsequent knee disarticulation. One patient with a short stump secondary to an ipsilateral proximal femoral focal deficiency had a femorofibular arthrodesis. Five of these 10 extremities had a satisfactory result when reviewed at an average follow-up of 18 years. The patients were evaluated in reference to gait, range of motion (ROM) of the knee, quadriceps strength, prosthetic needs, and peer group sports activities. A strong quadriceps (> grade 4) was noted in all five patients who had a satisfactory result. Flexion contracture of the knee, when < 25 degrees, did not compromise the result.

Split tibialis posterior tendon transfer and tendo-Achillis lengthening for spastic equinovarus feet

Twenty-one patients with a minimum follow-up of 2 years who underwent combined split tibialis posterior tendon transfer and tendo-Achilles lengthening for equinovarus foot deformities were evaluated. The results in 15 of 18 ambulatory patients were graded as excellent or good; patients had marked improvement of their equinovarus foot deformity in both stance and swing phases of gait and became brace-free postoperatively. All non-ambulatory patients had a plantigrade foot. The complication rate was low, and patient satisfaction with the procedure was very high. In three patients, however, the procedure failed because of technical errors. We address the causes of failure and methods to avoid these errors. Preoperative computerized gait analysis does not appear to be essential in achieving a good result.

Triple osteotomy of the innominate bone in treatment of developmental dysplasia of the hip

Ten children (11 hips) who underwent triple innominate osteotomy between the ages of 11 and 16 years for treatment of symptomatic acetabular dysplasia and who had > 10 years of follow-up since operation were reviewed to determine if satisfactory results reported in an earlier review were maintained. The mean length of follow-up was 12 years (range 10-16 years). All hips were examined roentgenographically, and functional assessment was made with the Iowa hip scoring system. Ten of the 11 hips improved roentgenographically and eight improved functionally after operation. One hip required replacement arthroplasty 16 years after triple innominate osteotomy.

Complications associated with fracture of the neck of the femur in children

We reviewed 16 children with 16 displaced fractures of the femoral neck associated with complications. One was a transepiphyseal fracture, 12 were transcervical fractures, and three were basocervical fractures. The mean age at time of fracture was 11 years 7 months (range, 4 years 6 months to 16 years), and the mean length of follow-up after fracture was 6 years 11 months (range, 2-24 years). Complications in this series were avascular necrosis (AVN) (14 patients), nonunion (seven patients), premature physeal closure (15 patients), chondrolysis (seven patients), and coxa vara (two patients). Avascular necrosis, nonunion, and chondrolysis were associated with a poor outcome. Coxa vara or premature physeal closure alone was not responsible for a poor result.

Osseous and non-osseous coalition of the middle facet of the talocalcaneal joint

Sixteen patients (eighteen feet) who had a coalition of the middle facet of the talocalcaneal joint had operative resection of the coalition because nonoperative treatment, such as casts, failed to relieve the symptoms. The patients were symptomatic for an average of one and a half years (range, four months to two years) before they were seen by us. The average age at the time of the operation was fourteen years (range, seven to nineteen years). Three feet had resection with no material interposed, six had resection with interposition of fat, and nine had resection with interposition of half of the tendon of the flexor hallucis longus muscle. The average length of follow-up was four years (range, two to eight years). The result was excellent for eight feet, good for eight feet, and fair for one foot; for one foot, the result was poor because the coalition recurred. Three types of coalition were identified on preoperative computed-tomography scans that correlated with the operative findings. Type I was an osseous bridging of the middle facet joint (five feet). Type II (cartilaginous coalition) was marked narrowing of the middle facet joint with cortical irregularity (three feet). In Type III (fibrous coalition), there was only slight narrowing of the middle facet joint (ten feet). The type of coalition did not influence the result. Fibrous coalitions were the most difficult to detect; bone scintigraphy was used to confirm the diagnosis when other tests were equivocal. We believe that symptomatic coalition of the middle facet of the talocalcaneal joint should be treated with resection when non-operative methods fail to relieve symptoms.

Transepiphyseal fractures of the neck of the femur in very young children

Five severely displaced transepiphyseal fractures of the neck of the femur in five very young children were treated nonoperatively with a spica cast. Four of these fractures healed in varus, but two with an open proximal femoral physis corrected with growth. One fracture had an 18-month delay in diagnosis and treatment, but subsequently healed after a valgus osteotomy of the proximal femur and bone grafting. There was no case of avascular necrosis. We recommend initial nonoperative treatment with hip spica cast immobilization for this type of fracture in the very young child. If correction of residual coxa vara or limb length discrepancy is indicated, it may be done later.

Epiphyseometaphyseal cupping of the distal femur with knee-flexion contracture

An 11-year-old child with a history of receiving megadoses of vitamin A as an infant, and a 4-year-old child with a history of fulminant staphylococcal septicemia with multiple joint involvement presented with recalcitrant knee-flexion contractures. Roentgenography revealed epiphyseometaphyseal cupping (ie, epiphyseal invagination) of the distal femur. Osteotomy resulted in only temporary correction. Our experience suggests that in the skeletally immature child, skin traction, physical therapy, splinting, and, in some instances, two-pin tibial traction should be the treatments of choice.

Late acetabular dysplasia following early successful Pavlik harness treatment of congenital dislocation of the hip

We present the long-term results of Pavlik harness treatment in 61 patients with 74 affected hips. At the beginning of treatment, the hips were either dislocated and reducible or dislocated and irreducible. The average age of patients at follow-up was 12 years (range, 10-16 years). At 3- and 5-year follow-up, all of the hips appeared radiographically normal. However, at latest follow-up, 17% of the hips demonstrated changes in the acetabulum (an upward tilt of the outer portion of the acetabular roof or sclerosis in this area). This study emphasizes the importance of continued follow-up until patients treated for congenital dislocation of the hip reach skeletal maturity.

Intraspinal epidermoid tumors in children: problems in recognition and imaging techniques for diagnosis

Iatrogenic intraspinal epidermoid tumors are very rare. The similarity of the clinical manifestations of the tumor with other childhood problems can pose a problem in diagnosis. In addition, because of the lag in time between the lumbar puncture and the development of a symptomatic tumor, this relationship is overlooked and can cause a delay in diagnosis, as in the present report of four children. Magnetic resonance imaging was found to be superior to myelography in defining the tumor and its relationship to other structures inside the dural sac. All patients underwent surgical excision, with subsequent resolution of symptoms.

Detection of talocalcaneal coalitions by magnification bone scintigraphy

Fibrocartilaginous talocalcaneal coalitions are very difficult to identify on plain radiography in symptomatic children and adolescents before gross ossification occurs. Computed tomography (CT) has been successful in identifying osseous and some fibro-osseous coalitions. In this series, magnification imaging of the tarsus on bone scintigraphy in the medial-lateral projection correctly identified talocalcaneal coalitions, seven of the nine bars were fibrous or fibro-osseous. Three of the fibrous lesions were equivocal or normal on conventional radiography and CT. Physiologic accumulations of activity in the growing hind foot are also presented from a control pediatric population. Magnification scintigraphy of the hind foot is offered as an adjunct to plain radiography and CT in the diagnosis of elusive nonosseous subtalar bars.

Amputation or limb-lengthening for partial or total absence of the fibula

Thirty-two patients who had ablation of the foot by the Syme or Boyd technique for partial or total absence of the fibula, with subsequent fitting of a prosthesis, were compared with eleven patients who had lengthening of the lower limb by the Wagner method, to assess the long-term results of each procedure. The final results were evaluated on the basis of pain, limp, limb-length discrepancy, level of physical activity, and satisfaction of the patient. Of the thirty-two patients who had an amputation, twenty-eight (88 per cent) had a satisfactory result, compared with only six (55 per cent) of the eleven patients who had limb-lengthening. The amount of inequality between the lower limbs was classified as follows: Group I--the foot of the shorter extremity was at the distal third of the contralateral, normal limb, and the percentage of shortening was 15 per cent or less; Group II--the foot of the shorter extremity was at the level of the middle third of the contralateral, normal limb, and the percentage of shortening was between 16 and 25 per cent; and Group III--the foot of the shorter extremity was at the level of the proximal third of the contralateral, normal limb, and the percentage of shortening was greater than 26 per cent. Lengthening was best suited for patients in Group I who had stable hips, knees, and ankles and a plantigrade foot. Patients in Groups II and III were best served by ablation of the foot and fitting of a prosthesis.

Lesions of the patellar ligament

We report 18 cases of pain and tenderness in the mid-part of the patellar ligament in athletes. The condition may be disabling, but it responds to surgery. Ultrasound and CT scans were positive in all 17 confirmed cases, but ultrasound gave a better distinction between the cysts, granulation tissue, metaplasia, mucoid degeneration and congenital defects found at operation.

Corrective cosmetic supramalleolar osteotomy for valgus deformity of the ankle joint: a report of two cases

Valgus deformity of the ankle joint can cause pain in walking and a significant gait disturbance because of the altered ankle mechanics and the secondary planovalgus deformity of the foot. A technique of supramalleolar osteotomy that is cosmetically better than a closing wedge osteotomy for correction of this condition is described in two patients with hereditary multiple exostoses. The osteotomy is inherently stable, and minimal or no internal fixation is needed.

Calcaneonavicular coalition treated by resection and interposition of the extensor digitorum brevis muscle

Seventy-five feet in forty-eight patients that had calcaneonavicular coalition were evaluated at two to twenty-three years after resection of the coalition and interposition of the extensor digitorum brevis muscle. The result was excellent or good in fifty-eight feet (77 per cent). Three feet that were rated initially as having a fair result improved over time, and at the last follow-up the result in those feet was rated as good. Only five feet (7 per cent) had a poor result. The best results were in patients who had a cartilaginous coalition and who were less than sixteen years old at the time of operation.