Introduction Split tendon transfer of tibialis posterior (SPOTT) is a treatment option for the hindfoot varus deformity in patients with cerebral palsy (CP). The purpose of this study was to present the long-term results of the newly modified SPOTT procedure developed by our senior author and compare it with the standard SPOTT technique in equinovarus foot deformity due to CP. Method Our retrospective cohort study included patients with spastic foot deformity due to CP treated with the standard or modified SPOTT technique. Patients' age at the time of the surgery was ≥ five years with follow-up period of at least four years. Surgical outcomes were evaluated using Kling's criteria during the patient's last follow-up visit. Results The analysis included 124 patients (146 feet), where 105 feet were treated by the standard SPOTT technique and 41 feet by the modified SPOTT technique. Patients' median age at the time of the surgery was 11 years. Patients were followed-up for a median period of eight years during which the modified SPOTT technique showed significantly better surgical outcomes compared with the standard group (excellent/good results in 38 feet, 92.7%, vs. 79 feet, 75.2%, p = 0.02). Two groups of patients did not significantly differ in GMFCS level, age at the time of the surgery, or patient gender. There was similar distribution in CP patterns in the standard and modified groups; spastic hemiplegia was the most prevalent form, followed by spastic diplegia and spastic paraplegia. Overall, better surgical success was achieved in patients with GMFCS levels I-III (100%, 94.8%, and 69.8%, respectively). SPOTT procedure failure was frequently noticed in patients with GMFCS level IV (90.9%). ConclusionThe modified SPOTT procedure demonstrated efficiency and safety in patients with equinovarus foot deformity due to CP during the long-term follow-up. Compared with the standard procedure, the newly modified SPOTT technique showed significantly better surgical outcome, irrespective of the patients' gender, age, initial GMFCS level, and CP type.

Introduction/Objective Tibial plateau fractures constitute a significant group of injuries to a major weight-bearing joint. High-energy fractures are difficult to treat, as they entail articular depression, condylar displacement, dissociation of comminuted metaphysis, and closed degloving injuries. The principles of the treatment are anatomical reconstruction of the articular surface, restoration of the anatomical axis, fixation spanning the metaphyseal comminution, and further minimization of soft tissue injury. The aim of this study is to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of high-energy Schatzker IV, V, and VI tibial plateau fractures. Methods This retrospective study was conducted from 2013-2016 on 35 patients (36 fractures) with high-energy tibial plateau fractures classified as Schatzker type IV, V, and VI. The mechanisms of injury were road traffic accident, fall from a height and direct trauma. The fractures were closed in 26 cases and open in 10 cases. All patients were treated with ligamentotaxis and percutaneous fixation using Ilizarov fixator. Functional outcome was determined using the Knee Society Score. Results The mean follow-up period was 20 months. All fractures healed in an average time of 14 weeks. The range of knee flexion after one-year follow-up averaged at 100°. Average Knee Society Score in our study was 77. Conclusion Ilizarov external fixation is a safe and efficient treatment modality for high-energy tibial plateau fractures. It allows reconstruction of the articular surface, stable fixation, early rehabilitation, and care of soft tissue injuries.

Background/Aim: Segmental fractures represent complex tibial injuries, featuring a unique fracture type that is most commonly caused by a high-energy trauma. These fractures are considered to be a treatment challenge for orthopaedic surgeons due to their sporadic presentation, wide zone of soft tissue injury, and increased rate of complications. They are characterised by highly unstable intermediary segment and high rate of open fractures. The method of Ilizarov with its characteristics could offer many advantages over the existing operative techniques. This method, using a percutaneous approach, minimizes the intraoperative trauma and avoids the additional compromising of the biological environment at the fracture site. The aim of this study is to evaluate the results of Ilizarov fixator in treatment of segmental tibial fractures. Methods: We analysed 30 patients treated with an Ilizarov fixator between 2012 and 2017. Average age was 36 years (from 24 to 65). The most common mechanism of injury was a road traffic accident. Open fractures were noted in 22 cases. All fractures were reduced using indirect percutaneous techniques with a great focus on achieving the correct length, rotation and axial alignment of fragments. All patients were advised to bear weight as tolerated from the second postoperative day. Bone healing and functional results were evaluated according to criteria established by the Association for the Study and Application of the Method of Ilizarov. Results: Bone healing was achieved in all patients. The average time to union was 25 weeks (19 to 36 weeks). The bone results were excellent in 23 patients, good in five patients and fair in two patients. The functional results were excellent in 22 cases, good in 5 and fair in three cases. Eight patients had minor pin-tract infections, successfully treated with oral antibiotics. Patients were without any major complications. Conclusion: Ilizarov method is a safe and efficient treatment modality for segmental tibial fractures.

Introduction/Objective Nonunions of the distal humerus after unsuccessful surgical treatment represents a challenging surgical problem. The complexity of this condition is increased by bone atrophy, scar tissue, poorly vascularized bone fragment, limited elbow mobility, osteomyelitis, and local neurological damage. The advantages of using the Ilizarov external fixation method are stable fixation, adequate fracture reduction, and fragment compression accompanied by minimal soft tissue trauma, with the possibility of early elbow mobilization. This aim of this paper is to present the treatment results of 19 patients with nonunion of distal humerus after internal osteosynthesis managed by the Ilizarov external fixation method. Methods Nineteen consecutive patients were treated with the Ilizarov external fixator. The study group includes 11 male and eight female patients with an average age of 42 years. Surgical technique consisted of approaching the nonunion, removing loose fixation material, making resection and debridement of bone fragments, after which the Ilizarov fixator was placed. Rehabilitation of the elbow started in the early postoperative period. The functional status of the arm was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Results All the patients achieved solid bony union after an average of seven months from the application of the external fixator. In 17 patients radiographic analysis indicated the preservation of joint space, while two showed degenerative changes. All the patients showed improvement in elbow range of motion and significantly better DASH score with postoperative value of 21. Conclusion As a treatment of distal humerus nonunion, the Ilizarov external fixation method provides successful healing and increased range of motion in the elbow.

To examine the influence of the configuration of the first and second metatarsal (MT) bones on the development of hallux valgus deformity. To determine the extent to which the difference in the lengths of the first and second MT bones, measured distal to the Maestro line, contribute to the severity of the hallux valgus (HV) deformity defined by the size of the hallux valgus angle (HVA) and inter-metatarsal angle (IMA). On a sample of 319 feet with HV deformity the difference of measured lengths R = d (I MT) − d (II MT) was calculated The influence of differences (R) on the values of IMA and HVA as well as on the severity of deformities according to the formed groups was investigated. The influence of age on the development of deformities was examined separately as well as in conjunction with the determined difference in lengths. In 203 feet or 63.7%, a shorter MT bone was measured, while in 80 feet or 25.1% the first MT bone was longer than second ones and only in 36 feet or 11.3% there is no difference in the length of the 1st and 2ndMT bones distal to the Maestro line. A statistically significant correlation was found between the difference between the measured lengths of 1st and 2nd MT bones and IMA, while this correlation with HVA was not statistically significant. There is no statistically significant correlation or the effect of the difference in measured lengths (R) on the severity of hallux valgus deformity classified into three groups. A statistically significant correlation and impact of the age on the intensity of the deformity are established. A shorter 1st MT bone in correlation to the 2nd MT bone is accompanied by an increase in IMA and this correlation and impact are statistically significant. It was not established that there was a statistically significant influence of the length of the first and second metatarsal bone measured distal from Maestro line upon the values of HVA and severity of HV deformity. Age significantly contributes to the severity of the deformity.