The American journal of orthopedics
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Nutritional rickets, the classic form of vitamin D-deficiency rickets, is rarely seen in the setting of modern medicine. We report four cases of nutritional rickets diagnosed at the time of orthopedic evaluation at our institutions during a 3-year period. All patients were referred by their pediatricians for evaluation of bowlegs. ⋯ Genu varum, seen in the setting of relative short stature and low weight, with a consistent social history, should raise the suspicion for nutritional rickets. The continued prevalence of this disease entity must be recognized in both the primary care and the orthopedic surgery setting. Vitamin D supplementation and enhanced sunlight exposure serve as effective prophylaxis and treatment of this disease.
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Vertebral venous bleeding is frequently encountered during anterolateral cervical decompression. The present study was undertaken to identify the pattern and location of the vertebral vein in relationship to the vertebral artery in the inter-transverse and intra-transverse foraminal regions. Twenty-one cadavers were dissected to determine the anatomic features of the vertebral vein in the inter-transverse and intra-transverse foramina. ⋯ In six specimens (29%), there were no obvious venous structures related to the vertebral artery in its intra-transverse and inter-transverse foraminal course. The veins are contained in a fibrous and osseous tunnel as they descend through the transverse foramina. Subperiosteal dissection of fibrous tissue from the lateral aspect of the uncinate process after removal of the anterior wall of the transverse foramen may minimize hemorrhages from the vertebral vein in the inter-transverse and intra-transverse foraminal region during resection of the uncovertebraljoint or neural foraminotomy with retraction of the vertebral artery laterally.