Treatment of infected forearm nonunion and defects represents a difficult task for the operating surgeons. Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with cancellous autografts or the Masquelet technique have been reported to be useful and successful, but sometimes it is difficult to predict the outcome and cannot address simultaneous deformities or the need to apply gradual distraction for reduction of a chronically dislocated radial head. Ilizarov technique has an answer for such conditions. We report a 43 years old man with infected ulnar defect and dislocated radial head as a result of infected Monteggia fracture: the patient was successfully treated by Ilizarov bone transport after failed attempts by bone spacer and fibular graft.

PurposeProximal femoral ischemic deformities in the pediatric population is a challenging pathological situation. Many surgical techniques have been proposed to treat this problem, with variable reported results. We believe that a C-shaped pertrochanteric osteotomy plus neck lengthening utilizing distraction osteogenesis principles would restore the femoral anatomical ratios between neck, shaft, and the head, and redress the biomechanics of the proximal femur with resultant sufficient containment of the femoral head within the acetabulum.MethodsWe reviewed the results of 19 patients divided into two groups with proximal femoral ischemic deformities. Between 2002 and 2009, preoperative and postoperative clinical examination and radiographs were assessed measuring the neck–shaft angle (NSA), neck–epiphyseal angle (NEA), articulo-trochanteric distance (ATD), lateralization of the greater trochanter (LT), the angle of Wiberg (CEA), index of lateral head displacement by Reimers (IM), and lateral angle of displacement (LDA).ResultsAll patients were followed prospectively. Clinical outcome was assessed using Colton’s criteria, which showed average good improvement in function (58.9 %). Radiological indicators were assessed using Kruczynski’s criteria. For group I, the postoperative NSA, NEA, and CEA showed significant change (p < 0.01, p < 0.001, and p < 0.001, respectively). For group II, the postoperative NSA, NEA, and CEA showed significant change (p < 0.001, p < 0.001, and p < 0.001, respectively).ConclusionThe midterm functional results are favorable for the implementation of pertrochanteric osteotomy and distraction osteogenesis to treat proximal femoral ischemic deformities in the pediatric population.

Pediatric septic hip sequelae represent a challenging condition to the treating surgeons with conventional femoral and pelvic osteotomy being difficult to solve advanced head and neck destruction. Surgeons usually resolve to pelvic support osteotomy which is technically demanding and may require revision if performed before skeletal maturity. We report a 10 years old girl which had sequelae of septic coxitis Hunka type IVb, the patient was treated by a C-shaped pertrochanteric and Salter osteotomy and by applying Ilizarov methods of distraction histogenesis we did reduction and gradual lengthening of the femoral neck stump which was adapted to the acetabular cavity at last assessment, the clinical and radiographic parameters had improved significantly at 14 years long term follow-up and the patient was able to walk painlessly and without support. The case represents an introduction to an alternative surgical technique which makes future joint replacement more feasible.

Introduction: Bilateral developmental dysplasia of the hip is a challenging situation, closed and open reduction with or without pelvic and femoral osteotomies are all proposed. Methods: We investigated the feasibility of closed ilizarov reduction combined with Salter and femoral osteotomy to provide stable concentric hips. Results: We retrospectively reviewed 19 patients (38 hips). Tonnis Criteria, acetabular index and Centeredge angle were measured preoperatively and postoperatively. Acetabular index changed significantly (P<0,001), 80% were excellent or good according to Mckay, 25% were Ia and 69% were IIa Severin's criteria with at least three years follow-up. Conclusion: The midterm overall results are favorable for application of this technique. 中 文 摘 要 簡介: 雙側發育性髖關節發育不良是一種具有挑戰性的情況。閉合或開放復位與 有或沒有骨盆和股骨截骨術 的選項都有被提出。 方法: 我們調查了ilizarov閉合復位結合Salter和股骨截骨術以提供穩定和同心髖關節的的可行性。 結果: 回顧性分析19例(38)髖關節。托尼斯標準、髖臼指數及中心緣角分別在術前和術後測量。髖臼指數 改變顯著(P <0.001)，根據Mckay標準，80％優秀或良好；25％為Ia和69％為IIa Severin's標準。 隨訪至 少三年。 結論: 中期整體結果有利於該技術的應用。

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