Bony exostoses are benign osteocartilaginous growths that start close to growth plates. Approximately 30-60% of patients have forearm deformities. The commonly encountered forearm deformities in these patients are bowing of the radius, with or without ulnar drift of the carpus, radial head dislocation, shortening of the ulna, and radial head dislocation. The current study reported on the results of management of radial head dislocation for type IIb Masada and Oho classification of forearm deformities by Ilizarov ulnar lengthening and without tumor excision. A series of 12 patients with Masada type IIb deformity were treated by Ilizarov lengthening at AlHadra University Hospital, Alexandria, Egypt, during the period from January 2008 to June 2014. There were eight males and four females; the right forearm was affected in seven patients. The mean age of the patients was 8.7 years (range: 7.5-10 years). All cases showed ulnar shortening with distal ulnar exostosis and radial head dislocation (Masada type IIb). All patients were operated on under general anesthesia, with application of the Ilizarov frame to the forearm. The frame used was assembled of two complete rings; the proximal one was fixed to the proximal ulna and the distal ring was fixed to both radius and ulna. Ulnar osteotomy was performed between the two rings, followed by ulnar lengthening 10 days postoperatively to lengthen the ulna and pull down the radius. Over a follow-up period of 33.2 months (24-48 months), all patients showed spontaneous reduction of the radial head and correction of the forearm deformity. The range of motion improved: flexion increased from 117.5° (110-130°) to 145° (130-160°) and extension increased to 4.6° (0-10°), whereas it was 13.8° (10-20°) preoperatively and the supination increased from 46.3° (40-50°) preoperatively to 73.6° (65-80°) postoperatively. Pronation improved from a preoperative average of 37.9° (30-40°) to 70.8° (60-80°) at the end of follow-up. The average amount of ulnar length was 27.9 mm (25-35) and the duration of external fixation was 103.3 days on average, with a range of 90-130. Thus, the average external fixation index was 3.7 days/mm (range: 3.6-4.0). Gradual lengthening of the ulna and pulling down the radius with an Ilizarov frame is an excellent method for correction of forearm deformity in patients with multiple hereditary exostosis (Masada IIb). Early intervention is the key to achieving spontaneous reduction of the radial head in all patients without the need for corrective osteotomy or tumor excision. Level of evidence: level IV.

Ankle reconstruction prior to limb lengthening for was performed in 13 patients with fibular hemimelia with complete radiological absence of the fibula (type II). There were different degrees of absence of metatarsal rays. The hindfoot deformity was a heel valgus in 12 patients and equinovarus in 1 patient. The patients’ ages ranged from 9 to 26 months. Excision of the fibular anlage was performed with lateral subtalar and ankle soft tissue releases to restore the ankle and subtalar joint relationships. In all cases, the fibular anlage ended distally in a cartilaginous lateral malleolar remnant that was fused to the talus in two patients. This fibular remnant was advanced distally and fixed to the tibia with 2 Kirschner wires to recreate an ankle mortise. The period of follow-up ranged from 12 to 38 months. All patients had a stable ankle without tendency to valgus deformity or subluxation. The ankle range of movement was a mean of 27.3° plantarflexion (25–30) and 18° dorsiflexion (15–20). Reconstruction of the ankle in type II fibular hemimelia using advancement of the cartilaginous lateral malleolar remnant has produced encouraging results in the short-term but longer follow-up is needed.

The aim of this article was to evaluate the results of relapsed club foot management using a simple frame construct of Ilizarov external fixator. Between 2003 and 2008, 18 feet in 13 patients with relapsed club feet were treated by Ilizarov external fixator. All patients underwent previous surgery (1-3 operations). Average patient age at the time of the operation was 5.5 years and the average follow-up period was 15.8 months. Midtarsal osteotomy was undertaken in 3 feet and soft tissue distraction was undertaken in 15 feet with no soft tissue release except in 3 feet that needed tendoachillis lengthening. The average time of fixator application was 4.5 months. Out of 18 feet, 2 (11.1%) were rated as excellent, 11 (61.1%) as good, 4 (22.2%) as fair, and 1 (5.6%) as poor. Excellent and good results (72.2%) were considered satisfactory, while fair and poor results (27.8%) were considered unsatisfactory. Thus, the Ilizarov technique gave satisfactory results in cases of relapsed club foot that were difficult to treat by conventional methods. Longer follow-up is needed to assess the achieved correction and to detect any recurrence of the deformity.

Objective: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of femoral and acetabular version in developmental dysplasia of the hip (DDH). Materials and Methods: This was a cross-sectional study of 20 consecutive patients with DDH (27 dysplastic hips) who were examined with MRI. In dysplastic and normal hips (DDH and comparison groups, respectively), we evaluated the following parameters: osseous acetabular anteversion (OAA); cartilaginous acetabular anteversion (CAA); femoral anteversion; osseous Mckibbin index (OMI); cartilaginous Mckibbin index (CMI); and the thickness of the anterior and posterior acetabular cartilage. Results: The OAA was significantly greater in the dysplastic hips. The CAA, femoral anteversion, OMI, and CMI did not differ significantly between the normal and dysplastic hips. In the DDH and comparison groups, the OAA was significantly lower than the CAA, the OMI was significantly lower than the CMI, and the posterior acetabular cartilage was significantly thicker than the anterior cartilage. Conclusion: Our findings confirm that MRI is a valuable tool for the assessment of femoral and acetabular version in DDH. Preoperative MRI evaluation has great potential to improve the planning of pelvic and femoral osteotomies.

BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts. AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts. MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips. RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shentons line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shentons line (78.75%), and finally femoral head coverage (70%). CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.