Background. Dysplasia epiphysealis hemimelica (DEH) is rare and its main characteristic is osteochondromas of the epiphysis of long bones. Methods. We report a case of DEH of the ankle in an 8-year-old boy that was resected in 2005. Additionally we collect all the reported cases of DEH. The literature is reviewed regarding the treatment, prognosis, long term function, and patterns and areas affected by DEH. Results. In our case no complications were noted and our patient remains asymptomatic. Reviewing the literature we found that 73 authors have reported 144 cases from 1926 to 2013. We propose and describe a new classification that correlates with prognosis. According to our classification DEH is classified as types 1 with single lower limb involvement, 2 with multiple lower limb, 3 with single upper limb, 4 with multiple upper limb, 5 with upper and lower limb, and 6 with spine. Conclusions. All single lesions should be followed up and if indicated a whole body nuclear bone scan can be useful in identifying the existence of multiple affected joints. Type 1 lesions have better prognosis than 2 and have less chances of developing OA even if not resected. Resection, even if partial, can be a successful treatment for DEH.

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Purpose. The purpose of this paper is to present our technique for the treatment of periplate fractures. Methods. From 2009 to 2012 we treated three patients. In all cases the existing plate was left and the new one placed over the existing. Locking screws were placed through both plates. The other screws in the new plate were used as best suited the fracture. Results. In all cases less than 6 months had passed between fractures. None of the original fractures had healed. Mean followup was 2 years. All fractures proceeded to union within 7 months. No complications were recorded. All the patients returned to their normal activities and were satisfied with the results of their treatment. Conclusion. Our plate on plate technique is effective for the treatment of periplate fractures. A solid fusion can be achieved at the new fracture site without disturbing the previous fixation.

Skeletal trauma accounts for 10% to 15% of all childhood injuries, with approximately 15% to 30% of these representing physeal injuries. Talus fractures are rare injuries in children with an estimated prevalence of 0.008% of all childhood fractures. Cast immobilization is sufficient treatment for non-displaced fractures, however displaced fractures of the talus require surgical intervention to minimize the risk of trauma-related avascular necrosis (AVN) due to disruption of the vascular supply originating from the talar neck. A 13-yearold boy was brought to the accident and emergency (A/E) department following a road traffic accident while he was pillion riding a bike. Following the accident, he was unable to bear weight on his right foot and his anterior ankle region was swollen, with no neurological deficit or open wound. He had no other injury and no medical or surgical history. On review of the ankle and foot radiographs, he was noted to have a right talar neck fracture with subtalar and ankle dislocation. His computer tomographic (CT) images demonstrated a Hawkins Type IV talus fracture. Initial treatment involved a plaster of Paris (POP) back slab with the ankle in a neutral position. His right leg was elevated on pillows and treated with elevation and ice to alleviate the swelling. As the fracture was comminuted and displaced with ankle and subtalar dislocation, operative intervention (open reduction and fixation of talus with crossed K wires) was planned. The patient was discharged in below knee slab which was changed to a non-walking cast at two weeks. The patient was kept non-weight bearing until fracture united. These types of fractures are rare in children and proper clinical and radiological evaluation is essential. Such fractures should be reduced as early as possible to reduce the ischemia time thus prevent the chances of osteonecrosis. Lastly avoid tourniquets and stable anatomical reduction of fracture is must.