No abstract

Poliomyelitis is an infectious disease caused by a neurotrophic virus targeting anterior horn cells of lower motor neurons resulting in flaccid paralysis and represents a common condition in developing countries, and even nowadays, most of both treated and untreated cases result in foot deformities. Between 1994 and 2007, 27 patients were treated by classic ring Ilizarov fixator, aiming at producing a stable plantigrade and cosmetically acceptable foot and followed up for meanly 7.17 years. Additional procedures were performed if needed. The mean time in frame was 4.2 months. All the patients were satisfied with their gait, compared to preoperative status. A painless and plantigrade foot was obtained in all patients, and limb-length discrepancy was always corrected where present. No major complications were encountered. In conclusion, the Ilizarov method allows simultaneous progressive correction of all components of severe foot deformities associated with limb-lengthening discrepancy with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding important shortening of the foot.

Purpose Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA). Methods Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes. Results Spacer exchange was necessary for infection persistence in one case. At a minimum two year follow-up, 34 patients (89.5 %) showed no infection recurrence; among these 34 patients, 29 (85.3 %) reported no or moderate pain [visual analogue scale (VAS) ≤3]; mild to moderate handicap (Lequesne Algofunctional Index<7.5) was observed in 18 patients (52.9 %). No patient underwent revision for aseptic loosening, and no nail breakage was observed. Conclusions Two-stage cementless intramedullary nailing without achieving bone-to-bone fusion is a viable option for treating chronically infected TKA in selected, complex cases.

BackgroundThe purpose of this study was to determine errors in measurement of torsional profiles (TP) (torsional femoral angle, torsional tibial angle, and femoral ankle angle) among four orthopedic surgeons, experts, and non-experts in measurement, and the learning curve.MethodsTwenty-six lower extremities of 13 patients with spastic diplegia candidates for femoral/tibial derotational osteotomy had preoperative bilateral computer tomography (CT) scan grams to establish the TP. Each measurement was done by four orthopedic surgeons, two experienced clinicians and interpreters of CT imaging and two with limited clinical and imaging assessment experiences. Images were blinded and the surgeons made three determinations at least 5 days apart; the three angles were measured each time for each limb. Intra-observer and inter-observer variability were determined using bias, standard deviation, and interclass correlation coefficient.ResultsSignificant inter-observer variability and bias were noted between experts and non-experts (average variability: ICC experts: 0.88 ± 0.15; ICC non-experts: 0.91 ± 0.09). For non-experts, excessive bias (25° and 14°) was observed. An associated improvement in bias with additional measurement experience indicated a potential significant learning curve for interpreting these studies. Less inter-observer variability was observed between experts.ConclusionsMeasurement of TP is a reliable tool when used by experienced personnel, and their use as a preoperative tool should be reserved to ones with experience with such image assessments. Non-experts’ measurements produced a weak agreement when compared to experts’.