Proximal Osteotomy Research Articles

Percutaneous Hallux Valgus: An Algorithm for the Surgical Treatment.

Objective To present the clinical and radiographic results of hallux valgus surgical correction using four percutaneous techniques, chosen according to a predefined radiographic classification. Methods We prospectively evaluated 112 feet in 72 patients with hallux valgus operated over the course of 1 year. Percutaneous distal soft tissue release (DSTR) and the Akin procedure (DSTR-Akin) were performed in mild cases. In mild to moderate hallux valgus with distal metatarsal joint angle > 10°, we added the Reverdin-Isham (RI) osteotomy. In moderate cases with joint incongruity, we performed the percutaneous chevron (PCH). Finally, a Ludloff-like percutaneous proximal osteotomy fixed (PPOF) with a screw was proposed in severe cases with an intermetatarsal angle (IMA) > 17°. According to these criteria, 26 DSTRs-Akin, 36 PCHs, 35 RIs, and 15 PPOFs were performed. The mean follow-up was of 17.2 months (range: 12 to 36 months). The mean age at operation was 58.8 years (range: 17 to 83 years), and 89% of the patients were female. Results The mean preoperative hallux valgus angle (HVA) and the IMA decreased from 21° to 10.2° and from 11.2° to 10.3° respectively in the DSTR-Akin. In the RI, the mean HVA decreased from 26.6° to 13.7°, and the IMA, from 11.2° to 10.3°; in the PCH, the mean HVA decreased from 31° to 14.5°, and the IMA decreased 14.9° to 10.7°; as for the PPOF, the mean HVA decreased from 39.2° to 17.7°, and the IMA, from 11.8° to 6.8°. The average ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) increased from 49.2 to 88.6. The rate of complications was of 11%. Conclusion Our treatment protocol does not differ much from the classic ones, with similar results as well. We have as advantages less aggression to soft tissues and better cosmetic results. Level of Evidence: level IV, prospective case series.

A novel instrument for the prevention of condylar torque in bilateral sagittal ramus osteotomy when using bicortical screw fixation

When using the bilateral sagittal split osteotomy (BSSO) technique, rigid internal fixation (RIF) remains the standard method to accurately fix the distal and proximal osteotomy fragments. A concern with the use of RIF, especially with bicortical screws, is the increased risk of condylar torque and its functional consequences. This technical note introduces a new method for preventing torque of the mandibular condyles after BSSO, using a sagittal split space maintainer.

Proximal Fibular Osteotomy – Simplest and Most Effective Mean to Delay Total Knee Arthroplasty

Background: Osteoarthritis involves degeneration of articular cartilage seen with increasing age. The knee joint, the most common joint that falls prey to attacks of osteoarthritis, has 30% incidence in population above 60 years. Total knee arthroplasty (TKA) is the main surgical option for orthopaedics. Though it corrects the deformity and relieves pain, yet it is not the treatment of choice in younger population. This study aimed to validate the effects of proximal fibular osteotomy (PFO) as a newer technique in managing medial compartment knee osteoarthritis. Methods: The diagnosed patients for medial compartment knee joint osteoarthritis were selected for study from Dr. Ziauddin University hospital of Karachi. Excluded were aged less than 40 years, or with BMI more than 30, and patients with tri-compartmental arthritis. Medial and lateral joint spaces along with Oxford knee score were measured and recorded pre- and post-operatively. Patients underwent PFO after giving written and informed consent. Results: Total number of patients selected was 30 for this study; 21 (70%) females, and 9 (30%) males (mean age 58.8 years). Mean pre-operative measured medial joint space on standard antero-posterior (AP) radiograph was 0.442± 0.04 cm. Mean recorded pre-operative Oxford knee score was 23.87±3.74 mm. Improvement was observed in mean postoperative medial joint space to 0.572± 0 .066 cm and mean post-operative Oxford knee score to 40.2±5.8mm. Conclusion: This study concludes that PFO significantly improves joint function in patients with medial compartment osteoarthritis knee and may delay the need for total knee arthroplasty, if carried out at an appropriate stage. Keywords: Osteotomy; Osteoarthritis; Total Knee Arthroplasty.

Acute left heart failure in a McCune-Albright syndrome patient with negative preoperative cardiovascular system screening after proximal femur osteotomy – a case report

Acute left heart failure in a McCune-Albright syndrome patient with negative preoperative cardiovascular system screening after proximal femur osteotomy – a case report

Interlocking reconstruction-mode stem-sideplates preserve at-risk hips with short residual proximal femora.

We have evaluated the survivorship, outcomes, and failures of an interlocking, reconstruction-mode stem-sideplate implant used to preserve the native hip joint and achieve proximal fixation when there is little residual femur during large endoprosthetic reconstruction of the distal femur. A total of 14 patients underwent primary or revision reconstruction of a large femoral defect with a short remaining proximal femur using an interlocking, reconstruction-mode stem-sideplate for fixation after oncological distal femoral and diaphyseal resections. The implant was attached to a standard endoprosthetic reconstruction system. The implant was attached to a standard endoprosthetic reconstruction system. None of the femoral revisions were amenable to standard cemented or uncemented stem fixation. Patient and disease characteristics, surgical history, final ambulatory status, and Musculoskeletal Tumor Society (MSTS) score were recorded. The percentage of proximal femur remaining was calculated from follow-up radiographs. All 14 at-risk native hip joints were preserved at a mean final follow-up of 6.0 years (SD 3.7), despite a short residual femur, often after proximal osteotomies through the lesser trochanter. Overall, 13 of 14 stems had long-term successful fixation. Eight patients required no reoperation. Three patients required reoperation due to implant-related issues, and three patients required reoperation for wound healing problems or infection. There were no dislocations or fractures. At final follow-up the mean MSTS score was 24.9 (SD 4.1). Nine patients required no ambulation aids, and only one had a Trendelenburg gait. This interlocking, reconstruction-mode stem-sideplate reliably preserves native hip joint anatomy and function after large femoral resection with a short remaining proximal femur, both in the primary and revision setting. This is particularly important for preventing or delaying total femoral arthroplasty in young patients after oncological reconstruction. Hip abductor strength and function could be maintained by this method, and the risk of dislocation eliminated. The success of this technique in this modest series should be verified in a larger collaborative study and will be of interest to revision surgeons and oncologists. Cite this article: Bone Joint J 2021;103-B(2):398-404.

Treatment of Radius Curvus in a Young Dog with Association of Radial Physeal Stapling, Ulnar Ostectomy and Transarticular Dynamic External Fixator Techniques

Background: Radius curvus is a clinical manifestation of the premature closure of the distal ulnar physis and the most common physeal disease in dogs, representing 63% of all physeal injuries. There are few reports indicating the technique of stapling for treatment of radius curvus in squeletically immature dogs. The aim of this study is to report a case of radius curvus in a young dog successfully treated with a combination of 3 surgical tecniques: 1- Stapling the medial and cranial portions of the distal radial physis; 2- Oblique osteotomy of the proximal ulna and ostectomy of the distal ulna, and 3- Dynamic external skeletal fixation in the elbow joint.Case: A 5-month-old female dog was referred to the University Veterinary Hospital with a history of left thoracic limb deformity for 2 weeks. There was a history of possible traumatic event on the front limb, in addition to providing nutritional supplements daily. In the radiographic evaluation the changes were identified in the left thoracic limb: shortening of the ulna, procurvatum and medial angulation of the distal radius, increased joint space and articular incongruity of the elbow joint. The dog was subjected to surgical treatment by the combination of three main surgical techniques. For the stapling of the distal radial physis the surgical approach on the cranial-medial surface of the distal radius was made. Two surgical staples were positioned in the distal radial physis. Thereafter a caudal approach was made to the distal region of the ulnar diaphysis for the distal ostectomy of the ulna. A bone segment of 1 cm in length of the distal ulnar diaphysis was removed. Another caudal approach was made to the proximal region of the ulnar diaphysis and a proximal oblique osteotomy of the ulna was performed. For the dynamic external skeletal fixation in the elbow joint two Steinmann pins were inserted. The first pin was proximal to the supracondilar foramen of the humerus and the second pin was caudal to the trochlear notch of the ulna, both parallel to the joint surface. To create a dynamic system, the pin tips were connected with elastic rubber bands on the medial and lateral sides of the elbow joint. Clinical and radiographic revaluation were made at 15, 30 and 60 days after surgery. Total correction of the limb deviation was achieved at 60 days postoperative. Two years after the surgical procedure, the owner was contacted and reported that the dog was very well and with no change in the operated limb.Discussion: The most common cause of premature closure of the distal ulnar physis is trauma. Due to the proper conical shape of the distal ulnar physis, there is more predisposition to the compression of the germinative cells in traumatic events, leading to radius curvus disease. Another cause of the radius curvus is the nutritional disbalances. In the reported case the patient had both predisponent factors, although unilateral limb involvement suggested trauma with primary causative agent. The treatment included the interruption of the supplementation of the diet associated with surgical techniques. The stapling of the distal radial physis is usually indicated for mild angular valgus deviation. In the current case the technique was applied with success regardless of the higher grade of radial deviation. Generally, the ulnar ostectomy is preferred to the osteotomy, since it reduces the rate of ulnar osteosynthesis, ensuring that the restrictive effect of the ulna upon the radial growth does not restart. In the reported case the ulnar ostectomy was associated with ulnar osteotomy to achieve a more effective result. Furthermore, the proximal ulnar osteotomy is usually indicated when elbow subluxation is present. In the current case the joint congruence was improved with the use of the dynamic external skeletal fixator.

Proximal fibular osteotomy - a novel technique for surgical intervention in knee osteoarthritis and its application in the Indian scenario: A prospective study

Proximal fibular osteotomy - a novel technique for surgical intervention in knee osteoarthritis and its application in the Indian scenario: A prospective study

Prospective study of functional and radiological outcome of proximal fibular osteotomy for medial compartment osteoarthritis in elderly

Prospective study of functional and radiological outcome of proximal fibular osteotomy for medial compartment osteoarthritis in elderly

Results after treatment of congenital radioulnar synostosis: a systematic review and pooled data analysis.

Congenital radioulnar synostosis (CRUS) is one of the most common congenital disorders affecting the elbow and forearm, with the forearm being fixed in a range of positions usually varying from neutral rotation to severe pronation. The aim of this study, apart from a systematic review of all surgical procedures described for CRUS, is to derive any correlation between various influencing factors, outcomes and complications. This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format by an electronic literature search of Ovid, MEDLINE and the Cochrane Library databases. Grading was according to the Newcastle-Ottawa scale and the Modified Coleman Methodology Score. Demographic data, surgical procedures, outcomes and complications were analyzed. Outcome data were pooled to establish means and ranges across all studies. Spearman correlations were performed. A total of 23 articles, showing a poor overall study quality (all Level of Evidence IV), met the inclusion criteria. A total of 374 forearms with a mean age of 6.7 years (2.0–18.8) were analyzed. Derotational surgeries were more commonly performed (91%) than motion-preserving surgeries (9%). The mean deformity improved from 64.8° pronation (−75° to 110°) to a mean of 2.8° pronation (−50° to 80°). In total, 17.9% of patients presented with complications. A significant correlation was noted between age and major complications, proximal osteotomies and complications, and postoperative loss of reduction and double level osteotomies as the primary treatment modality. Most of the complications occurred above the threshold of 65–70° of correction and in children 7 years and above. Surgery is essential to improve the quality of life of children with CRUS. However, each type of surgery is associated with complications, along with the respective hardware being used in rotation osteotomies. Caution is, nevertheless, warranted in interpreting these results in view of the inherent limitations of the included studies.

Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study.

Complex ankle fractures accompanied with infection and segmental bone loss are a worrying issue. This prospective study was conducted to explore the effectiveness of using Ilizarov concepts in achieving salvage arthrodesis and reconstructing post-debridement defects in such complicated scenarios. A total of 44 consecutive patients (mean age 35.61 ± 8.57years, 30 males, 44 feet) of post-traumatic infected ankle fractures, who met our selection criteria, were enrolled and subjected to radical debridement and salvage arthrodesis using thebifocal bone transport concepts of Ilizarov. All patients were treated between 2012 and 2017 either by acute shortening compression of the arthrodesis site with re-lengthening (ASRL) through the created proximal metaphyseal osteotomy (group I, n = 20) or by gradual bone transport (BT) through the proximal osteotomy with gradual closure of the distal ankle defect (group II, n = 24). Plain-radiographs were used for radiological assessment. Clinically, the outcomes were objectively graded according to the Hawkins criteria, while subjectively the patients reported their satisfaction on a 1-5 points acceptance scale. The mean follow-up was 37.16 ± 5.31 (30-48months). Successful fusion was achieved in 43/44 patients, with a significantly (P < 0.05) lesser needs for bone-grafting in favour of group II. The results were good in 32 cases, fair in 11, and poor in a single case with no significant difference between the two groups. The acceptance scores were significantly (P < 0.05)superior in group II (3.08 ± 1.1points) than that group I (2.25 ± 1.4 points). Bifocal bone transport is effective in salvaging troublesome infected ankle fractures with bone loss. BT is more comprehensive and acceptable than ASRL with lesser needs for bone grafting.

Different reconstructive techniques for tumours of the distal tibia.

The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle. A total of 73 patients with a median age of 19 years (interquartile range (IQR) 14 to 36) were included in this retrospective, multicentre study. Reconstructions included intercalary resection in 17 patients, osteoarticular reconstruction in 11, and ankle arthrodesis in 45. The median follow-up was 77 months (IQR 35 to 130). Local recurrence occurred in eight patients after a median of 14 months (IQR 9 to 36), without a correlation with adequacy of margins or reconstructive technique. Major complications included fracture of the graft in ten patients, nonunion of the proximal osteotomy in seven, and infection in five. In the osteoarticular group, three of 11 patients developed radiological evidence of severe osteoarthritis, but only one was symptomatic and required conversion to ankle arthrodesis. Functional evaluation showed higher values of the Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores in the intercalary group compared with the others. Preservation of the epiphysis in patients with a distal tibial bone tumour is a safe and effective form of limb-sparing treatment. It requires rigorous preoperative planning after accurate analysis of the imaging. When joint-sparing resection is not indicated, ankle arthrodesis, either isolated tibiotalar or combined tibiotalar and subtalar arthrodesis, should be preferred over osteoarticular reconstruction. Cite this article: Bone Joint J 2020;102-B(11):1567-1573.

Fresh Cadaveric Study of the Distances between the Deep Plantar Arch and the Lesser Metatarsals at Risk During Osteotomy of the Lesser Metatarsals

Category:Midfoot/ForefootIntroduction/Purpose:Osteotomy of the lesser metatarsals is useful to treat forefoot deformity. Although there is the possibility that some arteries supplying the lesser metatarsals are injured during osteotomy, there are few informations about the distances from the deep plantar arch to the lesser metatarsals. This study aimed to identify the distances from the deep plantar arch to the lesser metatarsals and to reveal how osteotomy of the lesser metatarsals might injure the deep plantar arch.Methods:Twenty fresh cadaveric feet were injected with barium through the external iliac artery, and enhanced computed tomography images were assessed. The distance between the deep plantar arch and each lesser metatarsal was measured on both axial and sagittal images.Results:The distances between the deep plantar arch and the second, third, and fourth metatarsals on the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The distances from the distal epiphysis to the line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal on the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the proximal epiphysis were 23.0, 21.0, and 18.6 mm, respectively. The deep plantar arch coursed at the level of the middle third, proximal to this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) feet, respectively.Conclusion:This study suggested that overpenetration into the medial-plantar direction of the second metatarsal or the proximal-plantar direction of the fourth metatarsal during the shaft or proximal osteotomy might injure the deep plantar arch easily. This study also suggested that on the plantar aspect, the shaft or proximal osteotomy about 45-47 mm proximal to the distal epiphysis of the lesser metatarsal or 18-23 mm distal to the proximal epiphysis might damage blood flow of the deep plantar arch.

Extreme Chevron

Diaphyseal osteotomies have been successfully used in the treatment of moderate to severe hallux valgus owing to their high correction potential without the typical instability of proximal osteotomies. The author describes the extreme chevron technique, which has an excellent correction potential. The technique also provides great intrinsic stability, resulting from the osteotomy shape and extensive contact area between fragments, and extrinsic stability, resulting from the possibility of multiple fixation. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Quantitative Lesser Trochanter Profile Versus Cortical Step Sign in Assessing Femoral Malrotation After Femoral Nailing.

We describe the novel quantitative lesser trochanter profile (QLTP) technique to determine the magnitude and direction of femoral malrotation and to compare its performance with the cortical step sign technique. For this assessment, 9 orthopaedic surgeons estimated the magnitude and direction of femoral malrotation with each technique in 198 anteroposterior view images of the proximal cadaveric femur and osteotomy sites. Based on the results, the main benefit of the QLTP technique over the cortical step sign technique is the ability to determine the direction of femoral malrotation. The QLTP technique was also more accurate in measuring malrotation and had less error. However, the QLTP technique requires additional imaging, and the mean difference in error between the 2 techniques might not be clinically meaningful.

OUTCOME OF PROXIMAL FIBULAR OSTEOTOMY IN ISOLATED MEDIAL COMPARTMENT OSTEOARTHRITIS OF KNEE: A COMPARATIVE STUDY.

Aim: Outcome of Proximal Fibular Osteotomy in isolated medial compartment Osteoarthritis of Knee.&#x0D; Material and Methods: The present study was conducted in the department of Orthopedics Jawaharlal Nehru Medical College, Bhagalpur from july 2018 to jan 2019. 36 patients amounting to 50 knee joints (male and female between 40-60 years age group) with medial compartment OA Knee were recruited. Medial joint spaces along-with visual analogue score for pain were recorded pre-operative, immediate post-operative and at final follow up.&#x0D; Result: Significant improvement in mean visual analogue pain score (VAS), from 7.02 preoperative to 3.39 at the final follow up was observed (p-value &lt;0.001). Medial joint space opening from 1.01 to 4.11 at final follow up was observed.&#x0D; Conclusion: The objectives as well as functional outcome after proximal fibular osteotomy were satisfactory.&#x0D; Keywords: Medial compartment Osteoarthritis Knee, PFO

Proximal fibular osteotomy for medical compartment OA knee

Proximal fibular osteotomy for medical compartment OA knee

Do Different Tibial Osteotomy Techniques Affect Sagittal Alignment in Children with Blount Disease?

ObjectiveTo determine the radiographic outcomes following dome or wedge‐shaped proximal tibial osteotomy in the management of infantile Blount disease with a particular interest in sagittal alignment of the knee joint.MethodMedical records of patients with Langenskiöld stage 2 Blount disease (aged ≤5 years) who underwent surgical correction between January 2005 and November 2019 were retrospectively identified. Patients with metabolic bone disease, bone tumors, prior traumatic fractures, congenital anomalies, inadequate plain films, and incomplete medical documents were excluded. Patient characteristics (e.g. age, gender, and body mass index [BMI]) and surgical characteristics (e.g. side, type of surgery, and follow‐up times) were recorded. Antero–posterior (AP) and lateral knee radiographs were analyzed. Data were categorized by surgical technique as dome‐shaped proximal tibial osteotomy or wedge‐shaped proximal tibial osteotomy. The femorotibial angle (FTA) was used to evaluate the correction angle in varus deformities. Sagittal alignment of the lower limbs using the posterior tibial slope (PTS) angle was measured postoperatively at 3, 6, 12, and 24 months, and at the final follow‐up visit.ResultsThe present study included 72 surgeries of 46 patients who had undergone proximal tibial osteotomy. Twenty‐nine (63%) were male. The mean age of patients at the time of surgery was 34.50 months (range, 26–47). The mean weight was 23.11 ± 4.98 kg (mean ± SD); the mean height was 95.33 ± 6.36 cm, and the mean BMI was 25.32 ± 4.36 kg/m2. The mean duration of follow up was 4.77 ± 2.78 years. Sixty‐four patients (88.90%) received dome‐shaped proximal osteotomy of the tibia, while 8 (11.10%) received wedge‐shaped proximal osteotomy of the tibia. The average FTA of the total correction measured was 29.32° ± 7.98°. The demographic data of the two groups were not significantly different for gender, age, BMI, side follow‐up times, and the total correction of varus deformities. In the dome‐shaped osteotomy group, the mean correction of the FTA was 29.59° ± 7.45°. The mean degree of the PTS angle was 6.50° at 3 months, 6.38° at 6 months, 5.32° at 12 months, 5.17° at 24 months, and 5.53° at the final follow‐up visit. In the wedge‐shaped proximal tibial osteotomy group, the mean correction of the FTA was 27.25° ± 11.77°. The PTS was 6.00° at 3 months, 7.50° at 6 months, 7.00° at 12 months, 5.40° at 24 months, and 5.57° at the final follow‐up visit. No significant difference was observed in the radiological outcome between surgical techniques.ConclusionDome and wedge‐shaped proximal tibial osteotomies did not demonstrate significant differences in the PTS angle in children with Blount disease.

Comparative Assessment of Subtrochanteric Shortening Osteotomy and Paavilainen’s Proximal Osteotomy in Total Hip Arthroplasty for Crowe III–IV Dysplasia

The purpose of the study — to compare the results of the subtrochanteric shortening osteotomy and Paavilainen proximal osteotomy in the total hip arthroplasty for Crowe III and IV dysplasia. Material and Methods. It was performed 36 hip arthroplasties in the patients with Crowe III (12) and IV (24) dysplasia. Two methods of the shortening osteotomy were used: Paavilainen osteotomy (22) and subtrochanteric osteotomy (14). The average follow-up was 42.3±22.7 months (from 6 to 88). Among the patients, there were 25 (75.8%) women and 8 (24.2%) men with the average age of 51.5±13.1 and 34.6±20.4 years, respectively. Results. The lateral acetabular deficiency required the structural repair of the femoral head in 16.7% of the cases. The average length of the osteotomized fragment was 56.8±16.3 mm, the caudal displacement of the greater trochanter apex — 47.0±15.6 mm, the limb lengthening — 30.1±10.9 mm without the statistically significant difference between the groups. The consolidation was achieved on average in 7 months. The Harris score improved on average from 37.6±10.1 points to 76.1±17.6, p0.001 (78.1±15.3 in Paavilainen group and 72.9±20.9 in the subtrochanteric). The overall HOOS score increased from an average of 34.6±12.4 to 74.6±18.6 points, p0.001 (78.1±15.9 in Paavilainen group and 69.1±21.7 in the subtrochanteric). The statistically significant differences between the groups after the surgery were found only in the HOOS pain section. Paavilainen group showed higher scores. Various postoperative complications occurred in 27.8% of cases, 2.4 times more often in the subtrochanteric group. The revision was required in 4 cases out of 36 (11.1%): 2 cases (9.1%) in Paavilainen group and 2 cases (14.3%) in the subtrochanteric. The survival rate of the femoral component throughout the sample was 97.2%. There was only one case of the femoral component replacement in the subtrochanteric group. Conclusion. Both the subtrochanteric shortening osteotomy and Paavilainen proximal osteotomy have good reconstructive capabilities and sufficient efficacy. We were not able to identify the clear advantages of any of the described options for shortening osteotomy, probably due to the insufficient number of observations. In our practice, we give a preference to subtrochanteric shortening osteotomy of the femur.

Combined Technique for the Treatment of Infected Nonunions of the Distal Femur With Bone Loss: Short Supracondylar Nail-Augmented Acute Shortening/Lengthening.

To evaluate a combined technique for treating distal femoral bone defects after debridement of osteomyelitis, using an external fixator together with a short supracondylar nail. Retrospective study. Single tertiary referral center. Between 2003 and 2018, 23 patients with a mean age of 37.2 years (26-56) underwent surgery with the same technique to manage postdebridement defects in the distal femur due to osteomyelitis. This involved acute shortening and intramedullary fixation of the defect site, together with relengthening from a proximal osteotomy using simultaneous external fixation. Radiographic union, range of motion of the hip and knee, external fixation time and external fixation index, and limb length discrepancy were assessed. The mean follow-up was 51 months (18-192). Union was achieved in all patients without recurrence of infection during this follow-up period. The mean knee flexion was 120 degrees, and the mean extension deficit was 5 degrees at final follow-up. The mean limb length discrepancy improved from 5.5 cm (3-7) to 0.5 cm (0-2). The mean external fixation index was 29.2 d/cm (20-50), and the mean external fixation time was 115 days (90-150). Radiographic scores were excellent in 15 cases, good in 6, and fair in 2. Functional scores were excellent in 14 cases, good in 7, and fair in 2. This combined strategy was an effective method for treating distal femoral segmental bone defects after debridement of osteomyelitis, with a high rate of union and acceptable complication rates. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Proximal crescentric osteotomy in the treatment of severe hallux valgus deformity

Proximal crescentric osteotomy in the treatment of severe hallux valgus deformity