Background Despite multiple published reviews, the optimum method of correction and stabilisation of Blount’s disease remains controversial. The purpose of this study is to evaluate the clinical and radiological outcomes of acute correction of late-onset tibial vara by percutaneous proximal tibial osteotomy with circular external fixation using two simple rings. Weighing up the pros and cons and to establish if this method would be the method of choice in similar severe cases especially in a context of limited resources. Methods This study was conducted between November 2016 and July 2020. We retrospectively reviewed the clinical notes and radiographs of 30 patients (32 tibiae) who had correction of severe late-onset tibia vara by proximal tibial osteotomy and Ilizarov external fixator. The mean age at the time of the operation was 16.6 (± 2.7) years (range 13–22). Results The mean proximal tibial angle was 65.7° (± 7.8) preoperatively and 89.8° (± 1.7) postoperatively (p < 0.001). The mean mechanical axis deviation improved from 56.2 (± 8.3) preoperatively to 2.8 (± 1.6) mm postoperatively (p < 0.001). The mean femoral-tibial shaft angle was changed from –34.3° (± 6.7) preoperatively to 5.7° (± 2.8) after correction, with degree of correction ranging from 25° to 45°. Complications included overcorrection (three cases 9%) and pin tract infection (eight cases 25%). The mean Hospital for Special Surgery knee scoring system (HSS) improved from 51.03 (± 11.24) preoperatively to 94.2 (± 6.8) postoperatively (p < 0.001). The mean length of follow up period 33.22 (± 6.77) months, (rang: 25–46 months). At final follow up, all patients had full knee range of motion and normal function. All cases progressed to union and there were no cases of recurrence of deformity. Conclusion This simple procedure provides secure fixation allowing early weight bearing and early return to function. It can be used in the context of health care systems with limited resources. It has a relatively low complication rate. Our results suggest that acute correction and simple circular frame fixation is an excellent treatment choice for cases of late-onset tibia vara, especially in severe deformities.

Purpose: three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction.Patients and methods: a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm 3 . Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery.Results: Six patients received thinned ALT (mean size = 139 cm 3 ) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm 3 ). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69-86). All patients regained their walking capability.Conclusions: 3-D virtual planning of complex heel defects facilitates covering nonelliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility. | INTRODUCTIONHeel defects vary in severity ranging from simple skin defects to complex soft tissue and bony defects. Such defects may result from mechanical, chemical or thermal injuries in addition to tumoural resection, peripheral artery occlusive disease, diabetic neuropathy or prolonged bed recumbency (Struckmann et al., 2014). Hidalgo and Shaw have classified these injuries according to the degree of soft tissue and bony involvement into three types; type I (small soft tissue defects), type II (larger soft tissue defects without bony involvement),

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Background: Intercondylar humeral fracture is one of the commonest & challenging fractures of young adult and counts for about 30% of all elbow fractures. Aim: Evaluation of two groups of patients, group 1 and group 2 managed by double plates and group B by Y plate Materials and Methods: This Prospective study was conducted on 44 patients, Group 1 22 patient and Group 2 22 patient. The study included patients aged between 16-59 years with intercondylar humeral fracture type C according to AO classification while patients with compound fractures, osteoporotic bone, pathological fractures, and patients aging less than 16 years and more than 59 years were excluded.  Follow up at 3 and 6 months. Results: Range of movement after 3 & 6 months was 84±31 and 98±35 respectively in group 1 which was relatively high compared to 48±25 and 71±21 respectively in group 2. MAYO Elbow Performance Score after 3 & 6 months was 71±21 and 82±23 respectively in group 1 which was relatively high compared to 48±14 and 73±12 respectively in group 2.

In cerebral palsy, patients’ excessive femoral anteversion is one of the most common skeletal abnormalities. The general agreement is concurrent correction of both soft tissue and bony deformities during the same operative setting by combining open femoral derotation osteotomy (FDO) with soft tissue releases. Fifty-one children (75 lower limbs) with cerebral palsy with a mean age of 10.7 years (range 6–16 years) fulfilling the inclusion criteria who underwent percutaneous FDO and when needed customized soft tissue releases. Derotation was maintained by a pin-in-cast technique. The mean follow-up was 24 m (range 14–36 m) and gross motor function classification system, functional mobility scale (FMS) and anteversion angle using the Staheli rotational profile were evaluated. Femoral anteversion was accurately measured by hip ultrasonography followed by a preoperative three-dimensional gait analysis. Preoperative and postoperative data were statistically analyzed to reveal the validity of this method. Internal and external hip rotation improved significantly (P < 0.001, respectively). Mean cast and Schanz screw application time was 49 days and all patients achieved independent walking for at least 5 m within 7 weeks. FMS, ultrasonography measured hip anteversion and gait kinematics also improved significantly (P < 0.01, respectively). Two patients (3.92%) developed a mild knee flexion contracture which resolved completely with physiotherapy at 12 m. The pins-in-fiberglass cast provides sufficient rigid fixation to constitute a reliable and reproducible method permitting early weight bearing. It is versatile enough to allow concomitant soft tissue procedures and correction of other accompanying bony deformities.