Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.

Background Juvenile primary hyperparathyroidism (PHPT) is a rare endocrine disease. Its diagnosis might be masked by clinical, biochemical, and radiological features of rickets. Case presentation A 12-year-old Sudanese boy presented with progressive lower limbs deformity and difficulty in walking for six months. It was associated with fatigability, poor appetite, and generalized bone pain. On examination, he was thin, disproportionately short and pubertal, and had bilateral genu valgum deformity. X-rays showed osteopenia and signs of rickets. Biochemical workup revealed mildly elevated serum calcium, low phosphate, high alkaline phosphatase, and high parathyroid hormone with low 25-hydroxy vitamin D3. Celiac screening, liver function test and renal profile were normal. Serum calcium rose dramatically after vitamin D therapy. Genetic testing was negative for CYP2R1 and MEN1 genes. Ultrasound neck showed left inferior parathyroid adenoma which was surgically excised. Histopathology confirmed the diagnosis of parathyroid adenoma. Postoperatively, he had hypocalcemia which was treated with calcium and alfacalcidol. Corrective surgery is planned for the genu valgum deformity which markedly improved after parathyroidectomy. Conclusion Although PHPT is extremely rare in the young population, it should be considered in patients with rickets and elevated serum calcium at baseline or after initiating vitamin D therapy.

Background: Angular deformities of lower limb in Pediatric age group present very commonly to orthopedic and pediatric clinics, and it may be physiological or may be true deformities. [8] In the past, Osteotomies have been the mainstays of treating deformities even in children. Recently, guided growth techniques become widely used in management of coronal plan angular deformities around the knees. It is a less invasive technique compared to osteotomies. The results are more predictable and the process is reversible. The implants can be removed after the desired correction is achieved. To our knowledge, no such study had been done in Khartoum, Sudan. Purposes and questions: ''Does guided growth techniques using two hole reconstruction plate for the treatment of coronal plan deformities around the knee decrease joint deformity and growth retardation in children?'', does there is a correlation between the radiological outcomes and the type of deformity, and to identify the post-operative complications. Methods: This is a cross sectional descriptive hospital based study of 22 patients (30 limbs) gathered and treated during a period from 2018 to 2020 by a single surgeon employing a standardized technique. The inclusion criteria were all patients with coronal plane deformities around the knee with an open physis, regardless of pathological background. Patients with physiological genuvarum or genuvalgum or who had previous or concurrent surgeries for the same problem were excluded from the study. Patient’s age and gender were recorded. Mechanical axis deviation (MAD) distance, tibio‑femoral angle (TFA), mechanical lateral distal femoral angle, and mechanical medial proximal tibia angle were measured from a long standing anteroposterior radiograph, including the hip, knee and ankle joints. Results: The average age was 7.0±3.5 years, and the mean duration of treatment was 10.4 months, with “sick physis” requiring longer durations. There was significant association between types of deformity was associated, with gender with P value 0.003 which found that, majority of genuvarum deformity found in females and genuvalgum found in males. The mean rate of correction of TFA was 1.4°/month. The MAD distance improved from 34.1±18.0 to 9.8± 6.4. Conclusion: This study confirms that success rate by guided growth technique using two- hole reconstruction plate in management of coronal plane deformity around the knee is high. Younger patients had better and faster outcomes. The direction of the future research is on continuous follow up for those children for any rebound coronal plane deformity.

Introduction: Recurrent fractures is the most challenging problem in children with Osteogenesis imperfecta, a variety of surgical methods have been investigated to decrease the incidence of this problem. Objectives: The aim is to compare between the use of Elastic Stable Intramedullary Nail (ESIN) and Rush Pins in order to decrease fracture frequency and asses the complications associated with each method. Methods: A descriptive cross-sectional study was conducted in 40 children with Osteogenesis imperfecta, the age of the participants was between 3 - 16 years. 20 children with OI were operated using ESIN and 20 children with OI were operated using Rush pin. Results:Both techniques are effective in guarding against fractures and correcting the deformities. The rate of nail proximal migration was relatively higher in the ESIN group. The re-fracture rate was lower in the Rush rod group. The rate of recurrence of angular deformities were slightly higher in the ESIN group. The reoperation rate was higher in the ESIN group. Conclusion: Corrective osteotomy with use of (ESIN) or Rush rods works well in guarding against fractures, but the overall complications and reoperation rate is statistically lower when using Rush rods, however both techniques fail to follow bone growth and have a possible complication such as nail proximal migration, recurrence of deformities and also both techniques do need repeated surgeries. Recommendations: We recommend further studies to assess the outcome between (ESIN, Rush pin) and Telescoping rods, to assess the longevity of these implants and the precise time for exchange and to correlate between surgical interventions with the concomitant use of Bisphosphonates.