Supracondylar humeral fractures account for 60% of elbow fractures in childhood, with cubitus varus being its most common complication. It can be avoided by accurate assessment of distal humeral alignment after fracture reduction, and the Baumann angle is the usual measurement for this purpose. However, several reports demonstrate an inconsistency of this angle, and our hypothesis is that reliability could be improved with angles drawn between the trochlear physeal line and the humeral longitudinal axis. The aim of the study was to compare intra- and interobserver reliability between the Baumann angle and angles drawn between the trochlear physeal line and (1) humeral longitudinal axis (X-angle), (2) humeral lateral cortex line (Y-angle), (3) humeral medial cortex line (Z-angle). Angle measurements were performed on 141 distal humerus’ radiographs of children aged 3–10 years by five observers in a tertiary hospital. The measurements were compared for their intra- and interobserver agreement. All measurements showed good or excellent intraobserver agreement levels, with the highest for Z-angle [intraclass correlation coefficient (ICC) = 0.906] and the lowest for Baumann angle. There were also excellent interobserver agreement levels for all angles, the highest for Z-angle (ICC = 0.885). There are indications that Z-angle had higher agreement levels when compared to the others (ICC = 0.954; 0.936–0.969) in the group aged 7–10 years. The angle drawn between the humeral medial cortex and trochlear physeal line showed greater agreement than the other angles analysed, becoming a potentially useful tool for evaluation of children with supracondylar humeral fractures in daily practice.

Genu recurvatum is characterized as an hyperextension deformity of the knee in the sagittal plane and can be associated to structured equinus deformity of the ankle and foot. Amongst its causes are conditions like arthrogryposis, cerebral palsy, tibial tuberosity arrest, poliomyelitis and syndromes with generalized ligamentous hyperlaxity. The treatment of this condition can be challenging, specially when associated with equinus of the foot and, to date, aggressive methods such as femur or tibia osteotomies are the most used for its correction. We describe here a safe and minimally invasive technique with posterior hemiepiphysiodesis of the distal femur performed with transphyseal screws for correction of the genu recurvatum with apex on the distal femur associated with rigid equinus of the foot due to tarsal coalition. This technique has great potential for correcting the recurvate knee in the immature skeleton and can be an excellent alternative to the more aggressive methods currently used for the treatment of this deformity. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Subungual tumors of the hallux are rare, with a varied spectrum of differential diagnoses, and it may be challenging to reach the correct diagnosis. Depending on the health system where the patient will be treated, the specialist physician may follow different paths in the search for pathological definitions, which may lead to delays in obtaining the diagnosis and even to mistaken results. We present a case of a patient with a subungual tumor of the hallux, which represents the singular process above, aiming to demonstrate relevant differential diagnoses, determining factors for the correct diagnosis, and the importance of pathological elucidation for its proper treatment so that the outcomes for the patient are prevented. Level of Evidence V; Case Report; Expert Opinion.

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Combined angular deformities of the knee and foot are challenging clinical presentations for the orthopedic surgeon. We describe a surgical technique used in a 58-year-old man diagnosed with genu varum associated with progressive collapsing foot deformity and severe hallux valgus. The surgical team and the patient decided to perform a one-stage correction of all deformities. The procedure included corrective osteotomies with bone grafting and soft tissue reconstruction. The varus knee, hindfoot valgus, and hallux valgus were properly corrected intraoperatively with the surgical techniques described here. Satisfactory functional outcomes and excellent maintenance of the realignment were achieved at short-term follow-up. Level of Evidence V; Therapeutic Studies; Expert Opinion.