We evaluated the results of patients with Gustilo types II, IIIA and IIIB open tibial fractures managed early with the Ilizarov external fixator (IEF). Sixty patients (51 males, nine females; age range 20-62 years; mean age 32.8 years) with type II (11 patients), type IIIA (13) and type IIIB (36) tibial diaphyseal fractures underwent emergency debridement and minimal bone fixation (with external fixator), followed by definite fixation with the IEF after three to five days. Average duration of the hospital stay was 8.6 days. All fractures united with an average union time of 21.1 weeks (standard deviation [SD] 3.18) in type II, 21.7 weeks (SD 3.57) in IIIA and 24. 9 weeks (SD 5.14) in IIIB fractures. The difference between union time in type II and IIIA was not significant (p>0.05), but that between IIIA (and also type II) and IIIB was significant (p<0.05). The healing index in patients who underwent lengthening was 1.5 months/cm. The wounds in 27 patients were managed by delayed primary closure, in 19 patients with second intent (all IIIB), in 11 patients with skin grafting (mostly type IIIB fractures) and in three patients with musculocutaneous flaps. The most common complications of the procedure were pin tract infection and pain at the fracture site. Most of the patients were able to achieve good knee and ankle range of motion.

Purpose: The purpose of the study was to evaluate the effectiveness of debridement and application of Ilizarov ring fixator (IRF) in the management of infected tibial non-unions. Patients and methods: Twenty six patients with infected non-unions of tibia were managed by debridement and resection of infected portion ± partial fibulectomy and stabilization by Ilizarov ring fixator. Bone segment transport was done in 18 patients who had greater than 2.5 cm bone defect after debridement. Bone grafting was required in three patients to augment union. Results: All fractures united and infection eradicated completely. There were 13 excellent, nine good, and four fair results. Functional results were excellent in nine, good in 11, fair in five and poor in one. Pin site inflammation was the most common problem and occurred in 23 (88%) patients. There were no major complications or neurovascular complications. Conclusion: We conclude that debridement combined with Ilizarov ring fixator with or without partial fibulectomy is a reliable method of treatment of infected non-unions of tibia.

INTRODUCTIONHallux vulgus which literally means lateral deviation of great toe is in fact a complex deformity of the first ray that frequently is accompanied by deformity and symptoms in the lesser toes. It has multi factorial etiology like vulgus of greater toe, metatarsus primus varus, genetic factors, shoe wear and anatomic factors like pronated flat foot, abnormal insertion of tibialis posterior, long 1 st ray, increased obliquity of 1 st metatarso-medial cuneiform joint.1 The earliest records date back to eighteenth century. 2 Its incidence was found to be 31% greater in shoe wearing than nonshoe wearing Chinese population.3 Its main concerns are pain over 1 st metatarsophalyngeal joint (MTP), difficulty in shoe wear and cosmetics. Management is conservative to begin with like broad toe shoe wear, toe spacers, exercises and activity restriction; later on operative which attempt to correct the deformity. Hueter, 1870 suggested sub capital amputation of the metatarsal head as the treatment for hallux vulgus. 4 More than 130 surgical procedures have been described since then for it. These range from soft ABSTRACT Background: Hallux vulgus is common deformity of fore foot frequently resulting in pain at first metatarso phalyngeal joint and cosmetic problems. Hallux vulgus is particularly more common in shoe wearing populations. Ours being a sub Himalayan region with harsh and prolonged winters where shoe wearing is a must this condition is very common. Various surgical procedures have been described for its management. These range from soft tissue procedures to arthodesis of first metatarso phalyngeal joint. Distal first metatarsal osteotomy (Mitchell's osteotomy) is a time tested procedure in its management. Methods: Forty adult patients (56 feet) with symptomatic hallux vulgus, who did not respond to conservative treatment, were managed with Mitchell's osteotomy. Results: Results were assessed as per American Orthopaedic Foot and Ankle Society grading. More than ninety percent of our patients were fully satisfied with their pain relief and foot cosmetics while others were satisfied with some reservations. There was no major complication or non-union at osteotomy site. Conclusions: Management of hallux vulgus is conservative to begin with, measures like life style modifications, broad toed shoes, toe spacers and physical therapy are tried first. Surgical intervention is indicated if conservative measures fail to relieve symptoms. More than 130 surgical procedures have been described for hallux vulgus ranging from soft tissue procedures like MacBride's to arthodesis of first metatarso phalyngeal joint. Distal metatarsal osteotomy was first described by Hawkins in 1945 but was named after Mitchell who published his work in 1958. From our study we conclude that this is a time tested procedure for symptomatic cases of Hallux Vulgus not responding to conservative measures.

Abstract:Objective: