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Background: The anterior (Smith-Peterson) and medial (Ludloff) procedures are the most common approaches used for subluxation or dislocation in developmental dysplasia of the hip that cannot be treated conservatively. If conservative treatment has failed, additional procedures on the pelvic or femoral side may become necessary. Methods: In this prospective study we used a new subsartorial approach in the surgical treatment of 20 hips (17 patients of whom three had bilateral hip dysplasia) with a mean follow-up of 23.9 mo (range 22-26 mo). There were 16 hips in 13 girls and four unilateral hips in four boys. At surgery, the ages ranged from 9 to 24 mo, with a mean of 16.5 mo. The degree of initial hip subluxation was graded according to the Tönnis classification, with two hips (10%) type II, eight hips (40%) type III, and 10 hips (50%) type IV. We evaluated the clinical and radiographic outcomes of the patient cohort with the McKay and Severin classifications, respectively. Results: Clinically there were 15 hips (75%) with an excellent results and five hips with good results. According to the radiographic Severin classification, nine hips had an excellent result (type I), 10 had a good result (type II), and one hip had a fair result (type III). One hip (5%) developed avascular necrosis according to the Kalmachi and MacEwan classification but eventually had good clinical outcome precluding any surgical intervention. Two girls (10%) developed left lateral subluxation 3 mo postoperatively. Femoral derotation osteotomy was done 6 mo postoperatively. Conclusions: The subsartorial approach was a safe, reliable, and reproducible approach in the pediatric hip in patients younger than 2 yr of age who had not had a previous operation or a history of paralytic hip dislocation. We recommend this approach for surgeons who are familiar with the pediatric hip.

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Background: Comminuted fracture femur with bone loss is a high energy injury with variable clinical and radiological scenarios; therefore, management has been a challenge to Orthopaedic surgeons because of associated complications and absence of standard guidelines to organize the different treatment options. The aim of the work is to assess radiological and functional results of managing comminuted fracture femur with bone loss by mono lateral external fixator, study the technique of application and related complication. Methods: This retrospective case series study was done in May 2010 to December 2016 with mean follow up period 1.5 years and included 21 patients who were divided into two main groups, group (I) included 11 patients managed by acute shortening and distraction, and the group (II) included 10 patients managed by bone transport technique. Outcome in both groups was compared regarding time to union (external fixator time), length gained, healing index (external fixator time/length gained), bone results and functional results according to Paley. Complications in both groups have been compared and classified according to Paley into 3 categories: problems, obstacles, and sequelae.

Background: Long-standing infected nonunion and gap nonunion tibial fractures are difficult to treat and pose a challenging problem to orthopaedic surgeons. They may lead to residual deformity, persistent infection, knee or ankle contracture, and, at worst, can result in a painful and useless limb requiring amputation. Methods: This prospective study involved 30 patients (27 males and three females) with infected tibial nonunions treated by Ilizarov external fixation with acute shortening and distraction. The mean age was 40 yr with an average bone defect of 3.85 cm (range 2.5 cm to 6 cm). The duration of nonunion before treatment ranged from 6 to 48 mo with an average of 14 mo. The average number of prior surgeries was 1.5 (range 1 to 4). Eleven (36.66%) of the 30 patients had overlying soft-tissue compromise. The causative bacteria were identified and treated with the appropriate antibiotic for at least 6 wk (range 6 to 12 wk). Results: Most infected nonunited fractures in this series (86.66%) occurred in the productive age (four in the 3rd, eight in the 4th, nine in the 5th, and 5 in the 6th decades of life) indicating the socioeconomic impact of this severe injury. The time to consolidation ranged from 3.5 mo to 9 mo, with an average of 6 mo. All fractures united except one (3.33%), with 19 (63.27%) and eight (26.64%) patients having an excellent and good result and two (6.66%) patients having a fair result when applying the Association for the Study and Application of the Method of Ilizarov (ASAMI) classification. Functional results per ASAMI were 12 (39.96%), and 14 (46.62%) patients had excellent and good results. Twenty-seven (89.91%) had bony consolidation with complete remission of infection. The most common isolated bacteria were Staphylococcus aureus (10 patients) and Staphylococcus epidermis (four patients). The most common complication was pin track infection which occurred in all patients. All were uneventfully treated with proper wire/pin care and the appropriate antibiotics. Conclusions: Ilizarov fixation with acute shortening distraction technique is a safe and reliable method for treatment of infected tibial nonunion, however, with the potentially devastating complication of vascular injury during acute compression. The amount of acute shortening is done on an individualized basis as we could not identify safe limits for acute shortening. This technique deals with soft-tissue defects that may require treatment and precludes the need for complex microvascular procedures and secondary bone grafting at the fracture site.