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Purpose Evaluation of the advantages and limitations of the Taylor Spatial Frame (TSF) with regard to the healing index (HI), distraction-consolidation time (DCT), accuracy of correction complications, and cost of the device. Methods Comparison of results with the traditional Ilizarov apparatus and a unilateral Orthofix fixator in a consecutive patient series with 135 bony deformity corrections. Results The HI did not differ significantly between all three fixators and was 57 days/cm for all patients. The DCT was significantly shorter for the TSF (148 days) compared to the Ilizarov fixator (204 days) and the Orthofix device (213 days). The accuracy of deformity correction was higher for the TSF than the other devices. The mean values of the measured angles after correction did not differ, but the variance of the results was the lowest. Also, the total rate of complications was considerably lower for the TSF. The Orthofix device showed a high rate of angular deformity during treatment, whereas both ring fixators had a relatively higher number of pin-related problems. Conclusions The findings in our patient series suggest the use of the Orthofix apparatus for simple lengthening over short to median distances and the Ilizarov device for the correction of simple bony deformities and pure lengthening over long distances. The TSF allows multiplanar corrections and lengthenings without complex modifications of the device. But, due to the remarkably higher costs, it has not yet been established as our routine device. Level of evidence Level IV-case series. Therapeutic Study-Investigating the Results of Treatment.

Aims The purpose of this study was to analyze the incidence of the different ultrasound phenotypes of developmental dysplasia of the hip (DDH), and to determine their subsequent course. Patients and Methods A consecutive series of 28 092 neonates was screened and classified according to the Graf method as part of a nationwide surveillance programme, and then followed prospectively. Abnormal hips were followed until they became normal (Graf type I). Type IIb hips and higher grades were treated by abduction in a Tübinger orthosis until normal. Dislocated hips underwent closed or open reduction. Results Overall, 90.2% of hips were normal at birth. Type IIa hips (8.9%) became normal at a median of six weeks (interquartile range (IQR) 6 to 9). Type IIc and IId hips (0.67%) became normal after ten weeks (IQR 7 to 13). There were 19 type lll and eight type lV hips at baseline. There were 24 closed reductions and one open reduction. No late presentations of DDH were detected within the first five years of life. Conclusion The incidence of DDH was eight per 1000 live births. The treatment rate was 1% (n = 273). The rate of first operations on the newborn hip was 0.86, and rate of open surgery was 0.04. The cumulative rate of open surgery was 0.07. The authors take the view that early identification and treatment in abduction of all dysplastic hips in early childhood reduces the rate of open reduction and secondary DDH-related surgery later in life. Cite this article: Bone Joint J 2018;100-B:1399–1404.

Purpose The purpose of this study was to compare a minimally invasive chevron osteotomy technique (MIS group) and the wellestablished open chevron technique (OC group) for correction of hallux valgus deformity. Methods Patients who were scheduled to undergo a hallux valgus surgery by means of a distal chevron osteotomy were randomly assigned to one of the two groups. Pre-operatively, six weeks, 12 weeks, and nine months post-operatively the following outcome parameters were determined: Visual Analog Scores (VAS) of pain, the American Orthopedic Foot and Ankle Society (AOFAS) forefoot score, radiographic outcome measures, range of motion (ROM), and patient satisfaction. Results Forty-seven cases were analyzed (25 MIS group; 22 OC group). Both operative techniques achieved significant correction of the hallux deformity. The intermetatarsal angle (IMA) improved from 15.1°to 5.8°in the OC and from 14°to 6.8°in the MIS group, whereas the hallux valgus angle (HVA) improved from 28.3°to 8.5°in the OC versus 26.4°to 6.9°in the MIS group. No significant differences were observed between the groups by any of the determined outcome parameters. Regarding patient satisfaction, statistically significant differences were found between MIS and open surgery 12 weeks post-operatively in favour of the MIS group (p = 0.022). Conclusion With the minimally invasive chevron osteotomy, radiological and clinical outcome is comparable to the open technique.

Purpose Prior studies have reported improved gait performance and kinematics after total ankle arthroplasty (TAR) compared to ankle arthrodesis (AAD). Given these findings, AAD has been primarily considered as a salvage procedure that may lead to adjacent joint degeneration. Methods A total of 101 TAR and 40 screw arthrodeses were enrolled in a retrospective study with a prospectively designed follow-up examination that included gait analysis and outcome assessment with the AOFAS hindfoot score and FAOS questionnaire. Results Significant asymmetry in gait and reduced range of motion compared to normal remained after both procedures. Subjective outcome improved after both procedures, and pain was significantly better after TAR. Limited functional gains after TAR and joint degeneration to the same degree after both procedures was seen in the mid-term. Hindfoot fusion seemed to have a greater impact on postoperative function than ankle arthrodesis. Conclusion Considering only minor functional gains of TAR compared to AAD the implantation of current TAR designs in large patient series may be questioned.

Background: The aim of the present prospective randomized study was to evaluate the long-term outcomes of minimally invasive chevron osteotomy as compared with open distal chevron osteotomy for the correction of hallux valgus deformity. Methods: A randomized controlled design was applied. The following parameters were assessed at 6 and 12 weeks, 9 months, and 5 years postoperatively: the American Orthopaedic Foot & Ankle Society (AOFAS) Forefoot Score, a visual analog scale (VAS) score for pain, and a patient-satisfaction score. In addition, several radiographic parameters for hallux valgus correction and joint degeneration were collected. Range of motion was also assessed. Thirty-nine of 47 feet were available for analysis at the time of the latest follow-up. Results: During the 5-year study period, the outcomes of the minimally invasive technique were comparable with those of the open technique. No significant differences were seen between the 2 groups within 5 years postoperatively in terms of clinical outcomes (VAS, AOFAS, satisfaction), radiographic outcomes, joint degeneration, or range of motion. Conclusions: Five years after treatment, the outcome following minimally invasive distal chevron osteotomy is comparable with that for the open technique for hallux valgus surgery. Levels of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Introduction Nonunion is a common complication after intramedullary nailing of subtrochanteric femoral fractures. A more detailed knowledge, particularly of avoidable risk factors for subtrochanteric fracture nonunion, is thus desired to develop strategies for reducing nonunion rates. The aim of the present study therefore was to analyse a wide range of parameters as potential risk factors for nonunion after intramedullary nailing of subtrochanteric fractures. Materials and methods Seventy-four patients who sustained a subtrochanteric fracture and were treated by femoral intramedullary nailing at a single level 1 trauma centre within a 6-year period were included in this study. A total of 15 patient-related, fracture-related, surgery-related, mechanical and biological parameters were analysed as potential risk factors for nonunion. Furthermore, the accuracy of each of these parameters to predict nonunion was calculated. Results Nonunion occurred in 17 of 74 patients (23.0%). Of the 15 potential risk factors analysed, only 3 were found to have a significant effect on the nonunion rate ( p < 0.05): postoperative varus malalignment, postoperative lack of medial cortical support and autodynamisation of the nail within the first 12 weeks post-surgery. Accuracy of each of these 3 parameters to predict nonunion was > 0.70. Furthermore, the nonunion rate significantly increased with the number of risk factors (no risk factor: 2.9%, one risk factor: 23.8%, two risk factors: 52.9%, and three risk factors: 100% [Chi-square test, p = 0.001)]. Conclusions Our study indicates that intraoperative correction of varus malalignment and restoration of the medial cortical support are the most critical factors to prevent nonunion after intramedullary nailing of subtrochanteric femoral fractures. In addition, autodynamisation of the nail within the first 3 months post-surgery is a strong predictor for failure and should result in revision surgery.

Level III, comparative series.