[Synostosis of the bones of the wrist].
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The authors have seen 5 children aged between 12 and 16 years suffering from a painful foot described as a recurrent sprain. Movements of the subtalar joint were limited and radiographs showed a hypertrophic calcaneal spur projecting towards the navicular but without fusion between the calcaneus and navicular. The calcaneal spurs were resected with good results and with an immediate symptomatic improvement.
The authors have studied 32 tarsal coalitions in 20 children. Twenty two were between the talus and the calcaneum, 4 were medial and 6 were rare varieties. The diagnosis is often missed because 40 p. 100 of the children with tarsal coalition had no complaints. The indirect radiological signs have been analysed and precise techniques described for detecting the coalition. Only 11 feet were operated on. On 4 occasions the coalition was simply resected. This always gave a good functional result and good mobility was obtained in the subtaloid joint in 2 cases. The other cases were treated by triple arthrodesis. The authors consider that an earlier diagnosis would lead to better prevention of secondary deformities. The best indication for simple resection is in coalition between the calcaneum and the navicular.
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The authors discuss congenital synostoses in a 28-year-old patient. They emphasize the importance of early correction to prevent alteration of foot function and development of early deformities.
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Three congenital synostoses of the knee occurred in 2 patients. Complete bony epiphyseal fusion was present on the radiographs. This condition is a failure of joint formation in the early mesenchymal stage at 4--5 weeks gestation and appears as connected cartilaginous cell masses which later ossify. Involvement of other joints has been reported in the literature, but these may be the first documented cases of the condition in knee joints.
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