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Introduction: Medial compartment osteoarthritis is a common entity leading to significant morbidity in geriatric population. High tibial osteotomy is a time tested knee preserving operation. The fixation methods vary from internal fixation like plates and screws, to external fixators like dynamic uniaxial fixators and Ilizarov. In this study we have analysed the outcomes of medial opening wedge osteotomy using a unilateral dynamic external fixator (Orthofix) using the principle of hemi-callostasis. Method: We conducted a prospective cohort study involving 20 patients with medical compartment osteoarthritis. Medial HTO was performed using Orthofix TM external fixator in 20 patients (20 knees) and were followed up between January 2019 to February 2021.Functional and radiological outcomes were assessed using the KSS and KOOS scores and the alignment xrays respectively. Results: Out of 20 patients included in the study, the majority (18) were females the mean age in the group was 50.75 years (+6.06years) at time of surgery. The involvement of right knee was seen in 12 patients and left knee was involved in 8 patients. The average improvement in th HKA was 13+1.2 degrees. The Average corrected HKA was 183.05+4.2 degrees. There was significant improvement in the mean KSS score at 2years, from (44.15 ± 6.13) pre-operatively to (86.15 ± 6.41) post-operatively and was statistically significant (p<0.001). An average KOOS score was (45.81±4.38) pre-operatively which improved to (89.20±4.24) in the post-operative period which was statistically significant (p < 0.001). There was positive correlation between pre and post operative KSS values which was significant at p < 0.05 that is, patients with better pre operative KSS scores had Better post operative functional outcome. Conclusion:High tibial osteotomy is a good option for young physiologically active patients with medial compartment osteoarthritis. The dynamic external fixator allows accurate correction of HKA angle postoperatively. Appropriate patient selection, good pre-operative planning, patient education and precise surgical techniques are essential for success of HTO. Achieving HKA angle between 183 -186 degrees is the key for good functional outcome and pain relief.

Introduction: Post traumatic distal tibial deformities can cause long term complications. Type 3,4,&5 Salter harris physeal injuries have higher propensity for deformities and limb length discrepancy. Furthermore, altered mechanical alignment in these patients can lead to arthritis in adjacent joints. Management options are varied from acute correction using internal fixation to gradual correction using ringed external fixators. In this study we have detailed the outcomes of patients with post-physeal injury deformity around the ankle treated by acutre and gradual correction. Methodology: Fifteen patients with fractures involving the distal tibial epiphysis injury and deformity, presenting at Government medical college, Kozhikode, Kerala, India between 2010 and2018, were reviewed. All patients in age group of 5 to 15 years, both males and females, varus and valgus deformity of the ankle were included. Demographic data and hospital records were obtained, radiological records were taken from the patients at subsequent follow-ups at union and 2 years from last surgery. Results: There were nine boys and six girls with an average age at presentation of deformity was 14+ 0.528 years (range 9-15) years. 10 injuries were low energy type (sports/Running/slip and fall), while five were high energy type (motor vehicle accidents).Average duration of follow-up was 3.933 + 0.566 years with a range 2-10 years. Gradual correction of the deformity was done in 11 cases using a circular external fixator with hinges while acute correction was done in 4 cases. Average pre-operative deformity of the ankle was 30.4+7.17 degrees. Range -20 to 40 degrees (20 degrees). AOFAS was used to assess the improvement in the functionality of the ankle. The average improvement in the ankle score was 18 points after surgery. There was no significant difference between the varus and valgus ankles. On analysis of pre-operative and post-operative deformity, higher correction was achieved in varus ankles (27.11 degrees-p value-0.00087) as compared to average correction of 21.17 degrees (p value-0.0004) in Valgus ankles. Conclusion:From our study we concluded that Salter harris 3 and 4 have higher propensity for physeal bar formation, greater degree of deformity and limb length discrepancy. In case of gross deformities (>20degrees) gradual correction with an Ilizarov has better clinical, functional and radiological outcomes. In case of smaller deformities (<20 degrees) internal and external fixation gives equivocal results. In management of pediatric ankle deformity, principles of deformity correction have to be followed irrespective of internal or external fixation, acute or gradual correction.