The Taylor spatial frame uses the slow correction principles of the Ilizarov system but adds a six-axis deformity analysis incorporated within a computer program. To evaluate its use in our community, we used it in lengthening and deformity correction of the lower limbs to treat 22 cases from 1999 to 2001. There were 14 females and eight males (average age 16.5 years). Our target was lengthening in eight cases, correction of deformities in eight and both in six. The results were excellent in 18 cases, good in two, and fair in two. Despite the cost, patient profile and a steep learning curve, our results were encouraging but less favorable than with the Ilizarov external fixator.

Limb lengthening continues to be a real challenge to both the patient and the orthopaedic surgeon. Although it is not a difficult operative problem, there is a long and exhausting postoperative commitment which can jeopardize early good results. I aim to review the history, evolution, biology, complications and current concepts of limb lengthening. Ilizarov's innovative procedure using distraction histeogenesis is the mainstay of all newly developing methods of treatment. The method of fixation is evolving rapidly from unilateral external fixator to ring fixator, computer assisted and finally lengthening intramedullary nails. The newly manufactured nails avoid many of the drawbacks of external fixation but they have their own complications. In general, the indications for limb lengthening are controversial. The indications have been extended from lower limb length inequality to upper extremity lengthening, including humeral, forearm and phalangeal lengthening. A wide range in frequency of complications is recorded in the English literature, which may reach up to 100% of cases treated. With developing experience, cosmetic lengthening has become possible using external or internal lengthening devices with an acceptable rate of problems. Level of evidence: V.

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This study evaluates our early experience with unilateral humeral lengthening in children and adolescents. From 1995 till 2001, 16 cases with unilateral humeral shortening ranging from 5.5 to 15 cm were referred to our center. The cause was Erb's palsy in eight cases, epiphyseal injury in five cases and infection in three cases. The average age at operation was 13 years (range 8.5-17 years). Hybrid fixation using wires and half pins were applied to all cases to minimize the risk of operative neurovascular complications. Osteotomy was performed in the middle third of the humerus through a posterior approach. After a latent period of 5-7 days lengthening started at a rate of 0.33 mm every 8 h. At an average follow up of 3 years and 2 months (range 1 year and 4 months to 5 years and 6 months) there were 10 excellent and six good results. The average healing index was 28 days/cm. Complications included pin tract infection in all cases; radial nerve palsy in one patient whose humerus overlengthened by 2 cm but improved completely after compression; fracture of the regenerate in two cases.

Introduction Dyggve-Melchior-Clausen (DMC) syndrome is a rare autosomal recessive type of skeletal dysplasia. It is characterized by the association of progressive spondyloepimetaphyseal dysplasia (SEMD), microcephaly, mental retardation (MR), and coarse facies. The radiographic appearance of generalized platyspondyly with double-humped end plates and the lace-like appearance of iliac crests are pathognomonic and distinctive of DMC syndrome. The disorder results from mutations in the DYM gene mapped in the 18q12-12.1 chromosomal region. Materials and methodsIn this report, we studied 15 Egyptian cases with DMC syndrome from nine unrelated families. We aimed to emphasize the characteristic clinical and radiological features in order to differentiate the condition from other SEMDs and mucopolysaccharidosis (MPS). Patients were subjected to detailed history taking, three-generation family pedigree analysis, complete physical examination, anthropometric measurements, quantitative estimation, and two-dimensional electrophoresis of glycosaminoglycans in the urine and measurement of a-L-iduronidase and galactose-6-sulfatase enzyme activities to exclude Hurler and Morquio diseases (MPS type I and MPS type IVA), respectively. Other investigations were carried out whenever indicated. All patients were the offspring of consanguineous apparently normal parents. Positive family history and similarly affected sibs were noted, confirming the autosomal recessive inheritance pattern of the syndrome. Short stature, microcephaly, variable degree of MR, and coarse facies were constant features. The frequency of characteristic orthopedic and radiological findings was reported. Orthopedic surgical intervention was carried out for two patients. Conclusions The study concluded that DMC syndrome may be more frequent in Egypt than previously thought, especially due to misdiagnosis. Characteristic facial dysmorphism, body habitus, and pathognomonic radiological signs suggest the diagnosis and differentiate it from other types of SEMDs and MPS for proper genetic counseling and management.

Background: Sever's disease is directly associated with excessive usage of the heel bone and tendons. This may occur from any sports involving a lot of heel movement. The commencement of new sport or the beginning of new season may be linked with it. Children through puberty are particularly at danger since the heel bone is growing faster than the leg. The objective of this research was to conduct a current concept study on severity in the paediatric age range. Methods: This is an article of review, Searches in MEDLINE and Embase, Pubmed and CINAHL Plus were carried out within the same date period as follows: "Sever's disease; paediatric; orthopaedics." The most obvious sign of severe illness is heel discomfort, typically exacerbated by physical activity like walking, jogging, or skipping. Sometimes the discomfort may be so intense that it limps and affects physical performance in athletics. Sever's disease is most often clinically diagnosed and many doctors feel that radiographic assessment is unnecessary, however if calcaneal apophysitis is not identified without x-rays, an injury needing more severe treatment may be overlooked. Edematous alterations in calcaneal apophysis may occur via MRI, which may spread to neighbouring calcaneal tuberosity, The research indicates that most people with the Sever illness are able to return to sport in a few weeks to two months with appropriate management.

IntroductionIlizarov principles and hybrid fixation have improved the results of humeral lengthening. We reviewed the literature on humeral lengthening using different fixators with regard to indications, operative technique, results and complications. We also retrospectively reviewed 56 segments in 46 patients treated with humeral lengthening and deformity correction using Ilizarov external fixation. The etiology was achondroplasia (10 patients), epiphyseal injury (8 cases), infection (11 cases) and Erb’s palsy (17 cases). The average age at surgery was 14 years (range 8–20 years). The patients were assessed clinically and radiographically and DASH score was available for 36 segments. Follow-up ranged from 1−11 years. The magnitude of lengthening achieved ranged from 5−15.5 cm with an average of 9 cm. The average healing index was 29.5 cm (range 26–37 days). The percentage of area of lengthening to the original length ranged from 25 to 100% with an average of 55%. The average DASH (available for 36 segments only) score ranged from 15−40 preoperatively to 7−16 (P = 0.04) at last follow-up. Functionally, all the patients returned to their preoperative jobs and daily activities including sports.ComplicationsComplications included pin track infection in 46 segments, radial nerve palsy which recovered completely in 2 patients, fracture of the regenerate in 7 cases and premature consolidation of the regenerate in one case.ConclusionHumeral lengthening, whether unilateral or bilateral, is a valid method that improves the outcome following arm shortening and deformity correction, including angulation and rotation. Extensive lengthening up to 100% of the original length could be achieved without increasing the risk of complications.Level of evidenceIV, retrospective cohort.